Policies, practices, opportunities, and challenges for TB screening, a survey of sixty National TB Programmes

BackgroundTo meet incidence reduction goals, the Global Plan to End TB 2023-30 emphasises for the first time that detection of subclinical TB is a priority. WHO Systematic Screening guidelines (2021) have stressed the importance of CXR as a screening tool to achieve this including recommending the use of Computer Aided Detection (CAD) technology. MethodsWe conducted a cross-sectional survey of National TB Programmes who reported >1000 TB cases annually. The questions aligned with 2021 WHO screening guidelines and aimed to understand countrys practices, policies, and challenges when screening for TB disease. ResultsSixty of 123 invited countries responded representing 82% of the global TB burden. Only 66% carried out all 6 WHO-recommended steps to implement screening and 39% collected all 7 of the WHO-recommended datapoints for monitoring activity. Although most countries had a policy for using CXR and increasing CXR-based screening (77% and 68% respectively), 90% reported at least one significant barrier to implementing this and 92% reported at least one barrier to implementing CAD technology. ConclusionMany countries do not carry out all recommended steps for implementation and monitoring of TB screening and although CXR and CAD use are expanding and hold promise as tools to find people with TB, many programmes do not have adequate access to them. While global policy is in place that recommends the use of these tools more efforts should be made to support countries in tackling the barriers that prohibit implementation to make sure that we can close the TB case finding gap. What is already known on this topicSince the publication of the updated WHO TB screening guidelines there are limited published data on how countries carry out screening for TB disease and what the perceived challenges are for implementing screening from a country perspective. What this study addsThis study provides data on current and planned screening practices and policies within countries as well as the common challenges being faced to implement screening effectively. How this study might affect research, practice, or policyThis information will help developers, policymakers, funding agencies, and academics to better plan and support the roll-out of appropriate screening interventions.