2.1.2 The provider-initiated screening pathway to TB diagnosis

The provider-initiated screening pathway to TB diagnosis entails systematic identification of people with possible TB disease in a predetermined target group with tests, examinations or other procedures that can be applied rapidly. In those with a positive screening test result, the diagnosis must be established by one or several diagnostic tests and additional clinical assessments, which together are highly accurate.

Provider-initiated systematic screening requires careful planning in order to target the specific characteristics and needs of populations. Key stakeholders should be involved in planning, including district or regional managers, who are often familiar with specific implementation challenges, as well as stakeholders from the groups targeted for screening, to create a more people-centred approach (14).

Screening in low-risk groups has the potential to cause more harm than benefit – for example, by detecting more false-positive cases than true-positive cases and potentially overwhelming a stretched diagnostic service and diverting resources for more likely and symptomatic cases. Therefore, after relevant risk groups that potentially would benefit from screening have been identified, those groups at the highest risk should be prioritized. It is also necessary to choose the appropriate screening and diagnostic tests and algorithms for each risk group and for each epidemiological situation. A systematic, carefully planned approach avoids wasting resources and optimizes individual and public health benefits.

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