Population-wide active case finding as a strategy to end TB

Thu-Anh Nguyen; Alvin Kuo Jing Teo; Yanlin Zhao; Mamel Quelapio; Jeremy Hill; Fukushi Morishita; Ben J Marais; Guy B Marks

doi:10.1016/j.lanwpc.2024.101047

Population-wide active case finding as a strategy to end TB

Lancet Reg Health West Pac. 2024 Mar 22:46:101047. doi: 10.1016/j.lanwpc.2024.101047. eCollection 2024 May.

Authors

Thu-Anh Nguyen^{1

2

3}, Alvin Kuo Jing Teo^{2

3

4}, Yanlin Zhao⁵, Mamel Quelapio⁶, Jeremy Hill^{2

3}, Fukushi Morishita⁷, Ben J Marais^{2

3}, Guy B Marks^{3

8

9}

Affiliations

¹ The University of Sydney Vietnam Institute, Ho Chi Minh City, Vietnam.
² Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
³ The University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW, Australia.
⁴ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
⁵ Chinese Centre for Disease Control and Prevention, Beijing, China.
⁶ Tropical Disease Foundation, Makati, Philippines.
⁷ World Health Organization, Regional Office for the Western Pacific, Manila, Philippines.
⁸ School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.
⁹ Woolcock Institute of Medical Research, Sydney, Australia.

Abstract

Tuberculosis (TB) is the leading infectious cause of morbidity and mortality globally. Despite available tools for preventing, finding, and treating TB, many people with TB remain undiagnosed. In high-incidence settings, TB transmission is ubiquitous within the community, affecting both high-risk groups and the general population. In fact, most people who develop TB come from the general population. To disrupt the chain of transmission that sustains the TB epidemic, we need to find and treat everyone with infectious TB as early as possible, including those with minimal symptoms or subclinical TB who are unlikely to present for care. Important elements of an effective active case-finding strategy include effective social mobilisation and community engagement, using sensitive screening tools that can be used at scale, and embracing population-wide screening in high-incidence ('hot spot') areas. We require a better description of feasible delivery models, 'real-life' impact and cost effectiveness to enable wider implementation.

Keywords: High-incidence settings; Population-wide active case finding; Tuberculosis.

Publication types

Review