Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality

摘要: Twenty years of sky-high tuberculosis (TB) incidence rates and high TB mortality in human immunodeficiency virus (HIV) prevalence countries have so far not been matched by the same magnitude or breadth responses as seen malaria HIV programmes. Instead, recommendations narrowly focused on people presenting to health facilities for investigation symptoms, testing care. However, despite recent major investment scale-up services, undiagnosed remains highly prevalent at community level, implying that diagnosis slow incomplete. This maintains transmission exposes living with morbidity mortality. More intensive use screening, broader definitions target populations, expanded indications screening both inside outside facilities, appropriate selection new diagnostic tools, offers prospect rapidly improving population-level control TB. Diagnostic accuracy suitable (high throughput) algorithms barrier realising this goal. In present study, we review evidence available guide HIV-prevalent settings, ideally through combined TB-HIV interventions provide HIV, maximise entry care prevention. Ideally, would systematically test, treat prevent comprehensively, offering all facility attendees, households adults highest risk communities. are still held back inadequate diagnostics, financing paucity population-impact data. Relevant contemporary research showing need potential gains, pitfalls from intensified settings discussed review.