Global status of policies and practices for systematic TB screening in high-burden countries.

BACKGROUND: The global status of policies and practices for systematic TB screening has not been described since the World Health Organization (WHO) guideline update in 2021. In 2024, the WHO Global Programme on Tuberculosis & Lung Health commissioned a questionnaire survey and in-depth reviews of systematic screening for TB disease in high-TB-burden countries. METHODS: A short-answer and multiple-choice questionnaire was sent to the 30 highest-TB-burden countries to query national policies and the scale of systematic screening, prioritising practices and results among targeted populations. In eight of the 30 countries, mixed-methods in-depth reviews comprised national policy desk reviews; stakeholder interviews; subnational site visits; and analyses of TB cascade of care data from systematic TB screening (2021-2023). RESULTS: Systematic TB screening showed signs of expansion since 2021 in eight high-TB-burden countries. The questionnaire survey and in-depth reviews identified best practices including chest X-ray prioritisation in parallel with or replacing symptom screening, computer-aided detection for chest X-ray interpretation, machine-learning spatial analytics, and intensive community mobilisation. CONCLUSION: High-TB-burden countries have expanded systematic TB screening, but national data systems for monitoring and evaluation must be strengthened to evaluate systematic screening results. Funding and human resource mobilisation is critical for progress. Artificial intelligence and innovative tools may improve implementation quality, enhancing existing human workforce capacity in the context of limited resources.