Scaling-up symptom-agnostic, community-wide screening toward global tuberculosis elimination: opportunities, challenges, and lessons from history
There has been little change in global tuberculosis (TB) incidence in the 21st century. Although case notification has increased, millions of people with TB each year remain unreached. Recently there has been increased recognition that many people with undiagnosed, potentially infectious TB do not e...
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Elsevier
2025-06-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971225000980 |
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| author | Hanif Esmail Cecily Miller Dennis Falzon Gerard de Vries Obioma Chijioke-Akaniro Katherine C. Horton Mikashmi Kohli Tejaswini Dharmapuri Vachaspathi Luan N.Q. Vo Syed M.A. Zaidi S. Bertel Squire Anna K. Coussens Rein M.G.J. Houben |
| author_facet | Hanif Esmail Cecily Miller Dennis Falzon Gerard de Vries Obioma Chijioke-Akaniro Katherine C. Horton Mikashmi Kohli Tejaswini Dharmapuri Vachaspathi Luan N.Q. Vo Syed M.A. Zaidi S. Bertel Squire Anna K. Coussens Rein M.G.J. Houben |
| author_sort | Hanif Esmail |
| collection | DOAJ |
| description | There has been little change in global tuberculosis (TB) incidence in the 21st century. Although case notification has increased, millions of people with TB each year remain unreached. Recently there has been increased recognition that many people with undiagnosed, potentially infectious TB do not experience or report TB symptoms. Symptom-agnostic screening (e.g., by chest X-ray) can effectively identify such forms of TB. Although this activity is increasing globally and is beneficial to individuals screened, current levels fall far short of what is needed to impact transmission and population-level prevalence. A significant scale-up of symptom-agnostic screening across communities is required to improve treatment coverage and interrupt transmission. Although there are major political, financial, and health system challenges to undertaking such scale-up this is not without precedent. In the mid-20th century, in many countries that now experience a low TB burden, population-level chest X-ray screening was successfully undertaken and contributed to the decline in TB. In this article, we explore the challenges and opportunities that face countries wanting to scale-up symptom-agnostic screening and reflect on important lessons from the past. |
| format | Article |
| id | doaj-art-8bb484402c0e42b0a96842265d0fde76 |
| institution | OA Journals |
| issn | 1201-9712 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj-art-8bb484402c0e42b0a96842265d0fde762025-08-20T01:49:19ZengElsevierInternational Journal of Infectious Diseases1201-97122025-06-0115510787510.1016/j.ijid.2025.107875Scaling-up symptom-agnostic, community-wide screening toward global tuberculosis elimination: opportunities, challenges, and lessons from historyHanif Esmail0Cecily Miller1Dennis Falzon2Gerard de Vries3Obioma Chijioke-Akaniro4Katherine C. Horton5Mikashmi Kohli6Tejaswini Dharmapuri Vachaspathi7Luan N.Q. Vo8Syed M.A. Zaidi9S. Bertel Squire10Anna K. Coussens11Rein M.G.J. Houben12WHO Collaborating Centre for Tuberculosis Research and Innovation, UCL Centre for Global Tuberculosis Research, Institute for Global Health, University College London, London, United Kingdom; MRC Clinical Trials Unit at University College London, London, United Kingdom; Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Pathology, University of Cape Town, Cape Town, South Africa; Corresponding author.World Health Organization, Global Programme on Tuberculosis & Lung Health, Geneva, SwitzerlandWorld Health Organization, Global Programme on Tuberculosis & Lung Health, Geneva, SwitzerlandCentre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The NetherlandsNational Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Abuja, NigeriaDepartment of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United KingdomFIND, Geneva, SwitzerlandTreatment Action Group, New York, USAFriends for International TB Relief, Ha Noi, Vietnam; Department of Global Public Health, WHO Collaboration Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, SwedenWHO Collaborating Centre for Tuberculosis Research and Innovation, UCL Centre for Global Tuberculosis Research, Institute for Global Health, University College London, London, United Kingdom; Department of Public Health, National University of Medical Sciences, Rawalpindi, PakistanFaculty of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United KingdomCentre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Pathology, University of Cape Town, Cape Town, South Africa; Infection and Global Health Division, Walter and Eliza Hall Institute of Medical Research (WEHI), Department of Medical Biology, University of Melbourne, Parkville, AustraliaDepartment of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United KingdomThere has been little change in global tuberculosis (TB) incidence in the 21st century. Although case notification has increased, millions of people with TB each year remain unreached. Recently there has been increased recognition that many people with undiagnosed, potentially infectious TB do not experience or report TB symptoms. Symptom-agnostic screening (e.g., by chest X-ray) can effectively identify such forms of TB. Although this activity is increasing globally and is beneficial to individuals screened, current levels fall far short of what is needed to impact transmission and population-level prevalence. A significant scale-up of symptom-agnostic screening across communities is required to improve treatment coverage and interrupt transmission. Although there are major political, financial, and health system challenges to undertaking such scale-up this is not without precedent. In the mid-20th century, in many countries that now experience a low TB burden, population-level chest X-ray screening was successfully undertaken and contributed to the decline in TB. In this article, we explore the challenges and opportunities that face countries wanting to scale-up symptom-agnostic screening and reflect on important lessons from the past.http://www.sciencedirect.com/science/article/pii/S1201971225000980TuberculosisScreeningSymptom-agnosticAsymptomaticChest X-ray |
| spellingShingle | Hanif Esmail Cecily Miller Dennis Falzon Gerard de Vries Obioma Chijioke-Akaniro Katherine C. Horton Mikashmi Kohli Tejaswini Dharmapuri Vachaspathi Luan N.Q. Vo Syed M.A. Zaidi S. Bertel Squire Anna K. Coussens Rein M.G.J. Houben Scaling-up symptom-agnostic, community-wide screening toward global tuberculosis elimination: opportunities, challenges, and lessons from history International Journal of Infectious Diseases Tuberculosis Screening Symptom-agnostic Asymptomatic Chest X-ray |
| title | Scaling-up symptom-agnostic, community-wide screening toward global tuberculosis elimination: opportunities, challenges, and lessons from history |
| title_full | Scaling-up symptom-agnostic, community-wide screening toward global tuberculosis elimination: opportunities, challenges, and lessons from history |
| title_fullStr | Scaling-up symptom-agnostic, community-wide screening toward global tuberculosis elimination: opportunities, challenges, and lessons from history |
| title_full_unstemmed | Scaling-up symptom-agnostic, community-wide screening toward global tuberculosis elimination: opportunities, challenges, and lessons from history |
| title_short | Scaling-up symptom-agnostic, community-wide screening toward global tuberculosis elimination: opportunities, challenges, and lessons from history |
| title_sort | scaling up symptom agnostic community wide screening toward global tuberculosis elimination opportunities challenges and lessons from history |
| topic | Tuberculosis Screening Symptom-agnostic Asymptomatic Chest X-ray |
| url | http://www.sciencedirect.com/science/article/pii/S1201971225000980 |
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