Scaling-up symptom-agnostic, community-wide screening toward 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 Dharmapuri Vachaspathi, Tejaswini Vo, Luan N Q Zaidi, Syed M A
Esmail, Hanif
Miller, Cecily
Falzon, Dennis
de Vries, Gerard
Chijioke-Akaniro, Obioma
Horton, Katherine C
Kohli, Mikashmi
Dharmapuri Vachaspathi, Tejaswini
Vo, Luan N Q
Zaidi, Syed M A
Series / Report no.
Open Access
Type
Journal Article
Historical Article
Review
Article
Historical Article
Review
Article
Language
en
Date of publication
2025-03-09
Year of publication
Research Projects
Organizational Units
Journal Issue
Title
Scaling-up symptom-agnostic, community-wide screening toward global tuberculosis elimination: opportunities, challenges, and lessons from history.
Translated Title
Published in
Int J Infect Dis 2025;155:107875
Abstract
There has been little change in global tuberculosis (TB) incidence in the 21 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-20 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.