English Manual and Guideline on World about Health and Epidemic; published on 24 Mar 2021 by WHO

Executive summary
Tuberculosis (TB) is a leading cause of death from a single infectious agent, despite being largely
curable and preventable. In 2019 an estimated 2.9 million of the 10 million people who fell ill with TB
were not diagnosed or reported to the World Health Organization (WHO). The Political Declaration
adopted by the United Nations General Assembly in September 2018 at the High-Level Meeting on
the Fight Against Tuberculosis commits to, among other goals, diagnosing and treating 40 million
people with TB by 2022. In order to achieve this ambitious target, there is an urgent need to deploy
strategies to improve the diagnosis and initiation of care for people with TB. One of these strategies is
systematic screening for TB disease, which is included in the End TB Strategy as a central component
of its first pillar aimed at ensuring early diagnosis for all with TB.
To facilitate the implementation of TB screening at the country level, WHO published guidelines on
Systematic screening for active tuberculosis: principles and recommendations in 2013. Since then,
there have been important new studies evaluating the impact of screening interventions on both
individual-level and community-level outcomes related to TB, as well as new research evaluating
innovative tools for screening for TB – including the use of computer-aided detection of TB on digital
radiographs, C-reactive protein and molecular WHO-recommended rapid diagnostic tests for TB –
among important populations at high risk for TB disease.
In view of these new developments and due to requests by countries for more guidance, WHO
convened a Guideline Development Group (GDG) in 2020 to examine the evidence and update the
2013 guidelines. The GDG met in virtual sessions between June and October 2020 and proposed
several new and updated recommendations related to TB screening. WHO gratefully acknowledges
the work of the GDG members, the evidence reviewers, representatives of national TB and HIV
programmes, WHO colleagues, technical and funding partners, civil society representatives, patients
and all others who contributed to the data used to inform this guideline update.
The evidence reviewed to address the guideline questions was derived from several trials and other
studies, programmatic data, surveys and modelling work. The certainty of the evidence and the
strength of the recommendations were assessed using the GRADE (Grading of Recommendations
Assessment, Development and Evaluation) method. Decisions about the strength of a recommendation
and the evidence depend on the level of confidence in the estimates, as well as on other critical
considerations, such as acceptability, feasibility, resource use and impact on health equity