Consolidated Guidelines

2.5.2 Implementation considerations

A prisoner is anyone held in a criminal justice facility or correctional facility during the investigation of a crime, anyone awaiting trial and anyone who has been sentenced. In addition, people residing in a correctional facility are almost always in close contact with several other inmates; thus, whenever a person residing in a prison is diagnosed with TB, prisoners who have been in close contact with that person should be investigated (see Recommendation 4).

3.3.1.4 Molecular WHO-recommended rapid diagnostic tests for medical inpatients living with HIV in settings with a high TB burden

TB is the main cause of hospitalization and mortality among people living with HIV. The assessment of the performance of an mWRD used as a combined TB screening and diagnostic strategy for medical ward patients with HIV included 4 studies in Ghana, Myanmar and South Africa with a total of 639 participants (see Web Annex B, Table 15, and Web Annex C, Table 8).

4.1. Preparation for evidence assessment

Using the PICO (population, intervention, comparator and outcome) format, the WHO Steering Group drafted the initial questions. These questions were used to guide the systematic reviews and to assess the evidence to inform the development of the updated guideline document. The initial PICO questions were then revised based on feedback from the Guideline Development Group. The final PICO questions are listed below.

3.4 Tools for systematic screening for TB disease among children and adolescents

16. Among individuals younger than 15 years who are close contacts of someone with TB, systematic screening for TB disease should be conducted using a symptom screen including any one of cough, fever or poor weight gain; or chest radiography; or both

(new recommendation: strong recommendation, moderate to low certainty of evidence for test accuracy).

3.3 Tools for screening for TB disease among people living with HIV

11. Among adults and adolescents living with HIV, systematic screening for TB disease should be conducted using the WHO-recommended four symptom screen and those who report any one of the symptoms of current cough, fever, weight loss or night sweats may have TB and should be evaluated for TB and other diseases

(existing recommendation: strong recommendation, moderate certainty of evidence).

12. Among adults and adolescents living with HIV, C-reactive protein with a cut-off of > 5 mg/L may be used to screen for TB disease

3.2 Use of computer-aided detection software for automated reading of digital chest radiographs

10. Among individuals aged 15 years and older in populations in which TB screening is recommended, computer-aided detection software programmes may be used in place of human readers for interpreting digital chest X-rays for screening and triage for TB disease

(new recommendation: conditional recommendation, low certainty of evidence).

3.1 Tools for screening for TB disease among the general population and high-risk groups

9. Among individuals aged 15 years and older in populations in which TB screening is recommended, systematic screening for TB disease may be conducted using a symptom screen, chest X-ray or molecular WHO-recommended rapid diagnostic tests, alone or in combination

(new recommendation: conditional recommendation, very low certainty of evidence for test accuracy).

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