2.6.1 Summary of evidence and rationale

Exposure to silica dust and silicosis are among the strongest risk factors for TB, with a relative risk of 2.8–39 for silicosis, depending on the severity of the disease (30). Silicosis is common in miners (31, 32), which is a primary reason for the high incidence of TB among them, and this is often compounded by a high prevalence of HIV. TB patients with silicosis have an increased risk of death (RR: 3.0; 95% CI: 1.4–6.3) (33). Thus, while the quality of the direct evidence is low for the benefit of TB screening in employees in workplaces where they are exposed to silica, the GDG placed high value on ensuring that TB is diagnosed early in this risk group, which has a high likelihood of having undetected TB as well as other pulmonary diseases that may be detected through screening. This recommendation has not been changed from the 2013 guidelines as no new robust evidence was found to inform the subject since the last guideline meeting.

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