Systematic TB screening in high risk groups

Clinical description

The National Prevalence Survey indicated that certain population groups have a higher prevalence of TB. These groups include men, urban dwellers, and individuals aged over 55 years.

Other key populations requiring attention are prisoners, miners, ex-miners, PLHIV, health care workers and children.

People who are in close contact with patients with infectious TB are at high risk for TB infection and should actively and systematically be investigated for TB infection and disease, in line with NTP’s National Strategic Plan 2016 - 2020. Contact investigation contributes to early identification of active TB, thus decreasing its severity and reducing transmission to others, and identification of latent TB infection (LTBI). Furthermore, contact investigation can help identify people who require careful follow-up, such as those who were exposed to an index case of multidrug-resistant (MDR) or extensively drug-resistant (XDR) TB or people infected with HIV.

The following WHO recommendations2 are the basis for the following population targeted systematic TB screening:

Strong recommendations

• Close contacts of people with TB including MDR TB
• People living with HIV (PLHIV)
• Workers in silica exposed workplaces.

Conditional recommendations

• People in prisons and other penitentiary institutions, and prison staff;
• People with untreated fibrotic chest x-ray lesions;
• People in high TB burden settings (estimated TB prevalence >100/100,000 in the

general population) who are seeking care or who are in care and belong to selected risk groups, and health care workers.

• Geographically defined sub-populations with extremely high levels of undetected TB

(>1% prevalence), other sub-populations with very poor health care access.