SCREENING FOR TUBERCULOSIS

Abstract
The priority of a tuberculosis control program is to cure all those found to have the disease. When there are sufficient resources to achieve a >90% cure, active case finding in high risk groups can be implemented. In London, we demonstrated that screening could be undertaken outside the hospital using a simple questionnaire followed by tuberculin skin testing in those at high risk. Cost-effectiveness was determined by the number of cases of tuberculosis identified. Areas for debate encompass the identification of high risk groups without stigmatisation, the incidence of tuberculosis which makes screening worthwhile, the resources required, the frequency of screening, the relative merits of tuberculin testing, sputum smear and chest radiograph and the location of screening. The impact of screening programs can be measured by the frequency of false-negatives, the proportion of smear-negative to smear-positive pulmonary tuberculosis and the incidence of primary tuberculosis, especially in children. We have not found a reduction in adherence to treatment in patients with tuberculosis who have no symptoms.

Key words
Tuberculosis, rastreo, estudio sistemático, quimioprofilaxis, tuberculina

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