Scaling-up symptom-agnostic, community-wide screening towards global tuberculosis elimination: opportunities, challenges and lessons from history

Esmail, Hanif, Miller, Cecily, Falzon, Dennis, de Vries, Gerard, Chijioke-Akaniro, Obioma, Horton, Katherine C., Kohli, Mikashmi, Vachaspathi, Tejaswini Dharmapuri, Vo, Luan N.Q., Zaidi, Syed M.A., Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038, Coussens, Anna K. and Houben, Rein M.G.J. (2025) 'Scaling-up symptom-agnostic, community-wide screening towards global tuberculosis elimination: opportunities, challenges and lessons from history'. International Journal of Infectious Diseases. (In Press)

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Abstract

There has been little change in global tuberculosis (TB) incidence in the 21st century. Although case notification has increased, millions of people with TB each year remain unreached. Recently there has been increased recognition that many people with undiagnosed, potentially infectious TB do not experience or report TB symptoms. Symptom-agnostic screening (e.g., by chest X-ray) can effectively identify such forms of TB. Although this activity is increasing globally and is beneficial to individuals screened, current levels fall far short of what is needed to impact transmission and population-level prevalence. A significant scale-up of symptom-agnostic screening across communities is required to improve treatment coverage and interrupt transmission. Although there are major political, financial, and health system challenges to undertaking such scale-up this is not without precedent. In the mid-20th century, in many countries that now experience a low TB burden, population-level chest X-ray screening was successfully undertaken and contributed to the decline in TB. In this article, we explore the challenges and opportunities that face countries wanting to scale-up symptom-agnostic screening and reflect on important lessons from the past.

Item Type:	Article
Subjects:	WA Public Health > WA 20.5 Research (General) WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) WF Respiratory System > Tuberculosis > WF 205 Epidemiology
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1016/j.ijid.2025.107875
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	02 Apr 2025 15:18
Last Modified:	02 Apr 2025 15:18
URI:	https://archive.lstmed.ac.uk/id/eprint/26353

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