The cost of screening, especially as an outreach activity, can be high. The opportunity cost must be considered and compared with other means for improving early TB detection, such as improving the patient-initiated pathway to TB diagnosis (see 2.1.1). The efficiency of a screening programme can be increased by collaboration with other health and social programmes. Outreach activities such as health promotion, social support or screening the targeted population for other health conditions may already be in place and may serve as platforms for TB screening within a broader, more integrated approach.
Identification of appropriate entry points for screening is critical, and this requires mapping the healthcare and social-service providers for relevant groups, such as endocrinology departments caring for people with diabetes or nongovernmental organizations providing social support for vulnerable groups. The private health care sector plays an important role in providing services to a large proportion of patients with TB, and, by involving them in TB screening, they may provide an entry point to TB care and treatment that would otherwise not be available.
Table 2.2 lists the programmes, services and stakeholders that could collaborate in screening activities.