Before the whistle blows: developing new paradigms in tuberculosis screening to maximise benefit and minimise harm

MacPherson, Peter ORCID: https://orcid.org/0000-0002-0329-9613, Williams, Caroline M., Burke, Rachael M., Barer, Michael R. and Esmail, Hanif (2021) 'Before the whistle blows: developing new paradigms in tuberculosis screening to maximise benefit and minimise harm'. Wellcome Open Research, Vol 6, p. 8.

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Abstract

We summarise recent emerging evidence around tuberculosis (TB) transmission and its role in tuberculosis epidemiology, and in novel TB screening and diagnostic tests that will likely become available in low-resource settings in the near future. Little consideration has been paid to how these novel new tests will be implemented, nor what the consequences for individuals, communities and health systems will be. In particular, because of low specificity and consequent false-positive diagnoses, and the low percentage of people who “screen positive” that will go onto develop active pulmonary disease, there is significant potential for inappropriate initiation of TB treatment, as well as stigmatisation, loss of livelihoods and in some setting institutionalisation, with uncertain benefit for individual health or community transmission.
We use analogy to prompt consideration of how and where new TB screening tests could be implemented in TB screening programmes in low-resource settings. Acceptance and confidence in TB screening programmes depends on well-functioning public health programmes that use screening algorithms that minimise harms and balance population benefits with autonomy and respect for individuals. Before new TB screening tests and algorithms are introduced, more evidence for their effectiveness, costs, benefits and harms under real-world conditions are required.

Item Type:	Article
Subjects:	WA Public Health > WA 105 Epidemiology WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WC Communicable Diseases > WC 20 Research (General) WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis
Faculty: Department:	Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI):	https://doi.org/10.12688/wellcomeopenres.16506.1
Depositing User:	Stacy Murtagh
Date Deposited:	05 Feb 2021 09:52
Last Modified:	05 Feb 2021 09:52
URI:	https://archive.lstmed.ac.uk/id/eprint/16893

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