Screening

The US Centers for Disease Control and Prevention and the US Preventive Services Task Force recommend that asymptomatic adults at increased risk of infection in the US are screened for latent infection, including persons born in or former residents of countries with high TB prevalence, current or former residents of high-risk congregate settings, people living with HIV, intravenous drug users, and contacts of individuals with pulmonary TB.[33][61]​​ Healthcare workers should be tested for latent infection if a TB exposure has occurred.[62] A tuberculin skin test or interferon gamma release assay are the standard method for identifying persons infected with the mycobacterium.[33] Screening persons other than high-risk population places a burden on resources and is therefore not recommended. Cochrane reviews of screening in children and in adults found that screening tests using symptoms or chest x-ray may be useful; however, better screening tests for tuberculosis are needed.[63][64]

Screening is only one aspect of controlling the disease; it is recommended that priority should be given to completion of treatment of active disease and investigating contacts.

The World Health Organization (WHO) guidelines on systematic screening for TB outline key populations who should be prioritised for TB screening.[65] Systematic screening is strongly recommended in the following populations:

  • People living with HIV

  • Household contacts and other close contacts of individuals with TB

  • People in prisons and penitentiary institutions

  • Current and former workers in workplaces with silica exposure.

Systematic screening is also conditionally recommended in the following populations:

  • Areas with an estimated TB prevalence of 0.5% or higher

  • Sub-populations with structural risk factors for TB, including urban poor communities, homeless communities, communities in remote or isolated areas, indigenous populations, migrants, refugees, internally displaced persons and other vulnerable or marginalised groups with limited access to health care

  • People with a risk factor for TB who are either seeking health care or who are already in care and TB prevalence is 0.1% or higher

  • People with an untreated fibrotic lesion seen on chest x-ray.

Screening tools recommended by WHO include symptom screen, chest x-ray, molecular rapid diagnostic tests, and C-reactive protein. Computer-aided detection is also recommended in some cases as an alternative to human interpretation of digital chest x-ray for screening and triage for TB.[65]

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