Enhancing Tuberculosis Screening Worldwide

Tuberculosis (TB) remains a major health issue worldwide. In 2022, it caused around 1.3 million deaths, making it one of the leading infectious diseases. Each year, about 4 million people with TB do not get diagnosed, allowing the disease to spread in communities. This situation has highlighted the need for systematic Screening and early detection of TB as essential steps to tackle this global health problem.

#How TB Screening Works

Screening for TB disease generally starts with checking for symptoms and using chest X-rays (CXR). If someone shows signs of TB, further tests, usually involving sputum samples, are done to confirm the diagnosis. However, many people with undiagnosed TB do not report symptoms, which makes it hard to identify them using standard screening methods. Regular CXR can help spot these hidden cases.

Recently, Computer-Aided Detection (CAD) technology has emerged. This software uses deep learning and artificial intelligence to help interpret chest X-rays for signs of TB. Studies suggest that CAD can be as accurate as human doctors in diagnosing TB from X-rays. The World Health Organization (WHO) now supports the use of CAD for TB screening in their guidelines.

#The Importance of Early Detection

The WHO and the Stop TB Partnership emphasize finding cases of TB as early as possible, even before symptoms appear, by using active case finding methods like CXR with CAD interpretation. Nonetheless, implementing these recommended methods comes with considerable costs for health systems. For instance, it was estimated that in 2022, nearly 400 million people would need to be screened for TB, costing about 5.3 billion USD in countries heavily affected by TB.

#The Need for Better Screening Practices

There is limited information on how countries perform TB screening and the challenges they face. Knowing these factors is important for everyone involved in health policy, funding, and research to prepare and support better screening methods. After the new screening guidelines were published, a global survey was conducted to understand countries' awareness of these guidelines, their current practices, and the challenges they face.

#Survey Design and Administration

The survey included questions related to TB screening that matched the 2021 WHO guidelines. It focused on three main areas: current practices, tools used, and barriers to expanding CXR-based screening. The survey was conducted online, and participants could respond in various languages. A total of 123 countries were targeted, and 60 of them responded, covering a significant portion of global TB cases.

#Current Screening Policies

Most countries were aware of the updated WHO guidelines. The majority had a national strategic plan for TB and planned to increase systematic screening for the disease. However, only two-thirds of the responding countries followed all six essential steps recommended by the WHO to implement an effective TB screening program.

#Who is Being Screened?

Countries were also asked about the populations they consider high priority for TB screening. Groups like household contacts, people living with HIV, and those in prisons were often seen as high priority. However, only a minority of countries had an existing screening policy for all key risk groups identified by the WHO.

#Monitoring Screening Activities

Many countries reported that most of their screening activities were documented, yet only a small fraction collected all recommended data points for monitoring these activities. While they mostly recorded TB diagnosis and treatment data, they fell short in collecting information about people eligible for screening.

#Tools Used for Screening

The survey asked countries about their screening approaches, particularly for adult contacts. Many used symptom screening followed by CXR. A significant number also planned to implement or expand the use of CXR in their screening efforts. However, only a small portion used CAD for interpreting CXRS, although many were interested in trying it.

#Barriers to Implementation

Countries cited numerous barriers to expanding CXR use for TB screening. High costs and the need for funding were the most frequently mentioned obstacles. Many countries also identified challenges with infrastructure and a shortage of qualified personnel to interpret X-rays.

#The Future of TB Screening

Despite the challenges, there is a commitment among countries to improve TB screening as part of their public health efforts. While many countries are planning to increase the use of CXR for screening, there are significant barriers, especially in terms of funding and resources.

The technology of CAD is gaining attention as a way to enhance screening efforts, and its accuracy has been supported by recent studies. Several organizations are working to help countries implement CXR and CAD, sharing valuable resources and guidance.

#Conclusion

In conclusion, while most countries are aware of the need for better TB screening and many have plans in place, there are still gaps in implementation. The lack of resources, funding, and comprehensive policies makes it challenging to fully realize the potential of screening to reduce TB cases.

As the global community continues to address TB, it is crucial to tackle these barriers and ensure that effective screening methods are accessible to all, particularly in high-burden countries. The commitment to screening will play a vital role in detecting and treating TB early, ultimately moving closer to eliminating this disease as a public health threat.