Policies, practices, opportunities and challenges for tuberculosis screening: a global survey of national tuberculosis programmes

Introduction There are limited published data on how countries carry out screening for tuberculosis (TB) disease and what the perceived challenges are for implementing screening from a country perspective. Understanding these factors are important to enable better planning and support for the roll-out of appropriate screening interventions. Methods We conducted a cross-sectional survey of national TB programmes from countries reporting >1000 TB cases annually. Results Sixty of 123 countries responded, representing 82% of the global TB burden. Only 35% of countries had a policy to screen for TB in all four key risk groups identified by WHO, 66% carried out all six WHO-recommended steps to implement screening and 39% collected all seven of the WHO-recommended data points for monitoring activity. Although 68% of countries planned to increase CXR-based screening, 90% reported at least one significant barrier to implementing this, and 20% were not aware of computer-aided detection (CAD) software technology. Conclusion Although chest X-ray 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, efforts should be made to support countries tackling these barriers.