The GDG considered that all three approaches – symptom screening, CXR and mWRD – may have roles in screening for TB disease in the general population. The ranking of the tools according to accuracy proposed by the GDG is: first, CXR; second, mWRDs; third, screening for any TB symptom (higher sensitivity and lower specificity); and fourth, screening for any cough or cough lasting 2 weeks or longer (lower sensitivity and higher specificity).
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).
Countries should position the W4SS, CRP, CXR and mWRD in combination with diagnostic evaluation using mWRDs and LF-LAM (8) within national TB screening and diagnostic algorithms according to their feasibility, the level of the health facility, resources and equity. Algorithms exploring the available screening tools are presented in the operational handbook, including modelled performance of accuracy and yield (7).
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).
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).
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
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).
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).
7. In settings where the TB prevalence in the general population is 100/100 000 population or higher, systematic screening for TB disease may be conducted among people with a risk factor for TB who are either seeking health care or who are already in care
(existing recommendation: conditional recommendation, very low certainty of evidence).
8. People with an untreated fibrotic lesion seen on chest X-ray may be systematically screened for TB disease
