Scoping review of community-wide screening to break the chain of TB transmission

SUMMARY BACKGROUND Active screening for TB may help address the global TB burden, but the optimal screening strategies are not defined. We have reviewed the effectiveness of community-wide active screening programmes to assess the characteristics associated with a reduction in TB. METHODS We performed a scoping review of community-wide screening studies since 1945 and summarised those that either provided TB prevalence data at the start and end of screening or compared the screening programme to a control community where screening was not performed. RESULTS Eight studies were identified in China, Czechoslovakia, Kenya, Malawi, South Africa, Uganda, Vietnam, Zambia, and Zimbabwe. Initial TB prevalence ranged from 84/100,000 to 1,014/100,000. Five studies demonstrated TB prevalence reductions from 44% to >80%, one showed evidence both for and against reduction, and two failed to demonstrate reduction. The successful studies were those that found, over the duration of the multi-year intervention, between 124% and 252% of the number of people with TB estimated to have been in the population at the beginning of the intervention, while unsuccessful studies found only 69%–83%. CONCLUSION Reducing the force of infection can be accomplished by performing multiple cycles of community-wide screening to reach substantial numbers of community members with TB.