6.3 Screening strategies and screening outcomes

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    People screening positive should be referred for active TB diagnosis (Chapter 3).

    People screening negative are unlikely to have active TB and should be referred for diagnosis and/or treatment of LTBI (Chapter 16).

     

    Table 6.1 – Examples of screening strategies by target group

     

    Screening strategies

    Positive screening

    Contacts and other high-risk groups (a) Citation a. In patients with chronic diseases (diabetes, etc.), detained persons and miners, symptom screening can be repeated as often as needed while CXR should be performed once a year.

    Ask for cough

    AND

    Perform CXR

    Presence of cough

    AND/OR

    Abnormal CXR

    Ask for cough

    THEN

    Perform CXR for those without cough

    Presence of cough

    OR

    Abnormal CXR

    Ask for any TB symptom:

    • Cough
    • Fever
    • Weight loss or poor weight gain
    • Night sweats
    • Haemoptysis
    • Reduced playfulness or lethargy in young children

    AND

    Perform CXR

    Presence of at least one symptom

    AND/OR

    Abnormal CXR

    Ask for any TB symptom (as above)

    THEN

    Perform CXR for those without any symptom

    Presence of at least one symptom

    OR

    Abnormal CXR

    Ask for any TB symptom (b) Citation b. Only if CXR is not available. (as above)

    Presence of at least one symptom

    Outpatient HIV-infected children < 10 years (c) Citation c. In HIV-infected children, CXR is not used as a screening tool.

    Ask for: 

    • Cough

    • Fever

    • Poor weight gain (d) Citation d. Including: underweight, growth curve flattening, weight loss.

    • Contact with a patient with TB

    Presence of at least one symptom

    AND/OR

    Contact with a patient with TB

    Outpatient HIV-infected adolescents (> 10 years) and adults on ART (e) Citation e. Symptom screening can be repeated as often as needed while CXR should be performed once a year. (f) Citation f. In HIV-infected adolescents and adults stable on ART and pregnant women, combination of W4SS + CXR allows detection of the largest number of active TB cases.

    Ask for W4SS:

    • Cough
    • Fever
    • Weight loss
    • Night sweats

    AND

    Perform CXR

    Presence of at least one symptom

    AND/OR

    Abnormal CXR

    Ask for W4SS (as above)

    THEN

    Perform CXR for those without any W4SS

    Presence of at least one symptom

    OR

    Abnormal CXR

    Ask for W4SS (as above) (b) Citation b. Only if CXR is not available.

    Presence of at least one symptom

     

    Other screening strategies are possible depending on resources and/or national recommendations. For example:

    • In contacts and other high-risk groups, screening can be based on CXR only.
    • In HIV-infected adolescents and adults not on antiretroviral therapy, C-reactive protein (CRP) may be used in combination with other screening tools.

     

    Note: digital CXR is preferred over X-ray film. Computer-aided detection (CAD) is particularly useful when CXR screening is performed in large populations (Chapter 3).

     

    • (a)In patients with chronic diseases (diabetes, etc.), detained persons and miners, symptom screening can be repeated as often as needed while CXR should be performed once a year.
    • (b) Only if CXR is not available.
    • (c)In HIV-infected children, CXR is not used as a screening tool.
    • (d)Including: underweight, growth curve flattening, weight loss.
    • (e)Symptom screening can be repeated as often as needed while CXR should be performed once a year.
    • (f)In HIV-infected adolescents and adults stable on ART and pregnant women, combination of W4SS + CXR allows detection of the largest number of active TB cases.
    Path