Assessment of screening and early detection practices for pulmonary tuberculosis

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis bacteria, and is spread from person to person solely through the air (coughing sneezing, etc.) when the disease is at the pulmonary tuberculosis stage.

In accordance with its work programme, the French National Authority for Health (HAS) has conducted an assessment of screening and early detection practices for pulmonary tuberculosis, at the request of the French Directorate-General for Health.

The objective of this public health guideline is to propose strategies to screen for the disease as early as possible so that it can be treated promptly, thereby restricting or stopped its progression and risk of transmission. In this context, the screening strategies assessed are aimed at detecting the presence of disease in individuals in seemingly good health, not yet displaying obvious symptoms (or only displaying symptoms not identified by the individuals concerned), but also at early detection of people at a subclinical stage of pulmonary tuberculosis (stage with little or no symptoms, but which is already contagious).

The assessment method is based on a systematic critical literature review, and consultation of professionals (meeting of external experts in a working group and consultation of shareholders). Following this work, the most effective strategies to implement have been defined:

• populations deemed to be at a risk of tuberculosis, for whom strict screening inclusion eligibility criteria have been defined;
• the most relevant screening / early detection algorithms tailored to target populations, points of access for these populations, and the resources available;

Two types of screening programmes according to the target populations: systematic screening and opportunistic screening:

• for adults and adolescents, the objective is to identify pulmonary tuberculosis in at-risk populations as early as possible (systematic screening), and to reduce the risk of loss of chance for target populations living outside the healthcare system (opportunistic screening);
• for infants and children, the objective is to refer them promptly for treatment because tuberculosis rapidly progresses to severe forms at this age.