Ethical issues should be considered from the onset of planning and should involve end-users. The design of screening interventions for specific risk groups should involve risk groups and organizations that might work with these populations, especially groups that face specific access barriers or discrimination. This should help in arriving at user-friendly, acceptable, effective approaches and building demand for services and their use.
Those invited for screening should be provided with detailed information, including the benefits and risks, and verbal informed consent should be obtained. Refusal of screening should be respected and should not lead to discrimination of any sort. Informed consent requires effective communication with each person about the uncertainties associated with screening, such as false-positive results and risk of overtreatment. Appropriate mechanisms for obtaining informed consent should comply with international human rights standards and account for different languages, literacy and legal status. Risk and uncertainty must be communicated in a way that is culturally and linguistically appropriate, including to people whose first language is foreign to the local setting, to children and to people in prison. Confirmatory tests should be available to ensure an effective diagnostic pathway. The privacy and confidentiality of all information related to screening should be ensured.
The risks of discrimination and stigmatization should be carefully assessed before initiating screening. Depending on the risks identified for different target groups, measures may be adapted to minimize the consequences.
Further information on ethical considerations can be found in the WHO Ethics guidance for the implementation of the TB strategy (28).