Before the whistle blows: developing new paradigms in tuberculosis screening to maximise benefit and minimise harm

MacPherson, P. , Williams, C. M., Burke, R. M., Barer, M. R. and Esmail, H. (2021) Before the whistle blows: developing new paradigms in tuberculosis screening to maximise benefit and minimise harm. Wellcome Open Research, 6, 8. (doi: 10.12688/wellcomeopenres.16506.1)

Abstract

We summarise recent emerging evidence around tuberculosis (TB) transmission and its role in tuberculosis epidemiology, and in novel TB screening and diagnostic tests that will likely become available in low-resource settings in the near future. Little consideration has been paid to how these novel new tests will be implemented, nor what the consequences for individuals, communities and health systems will be. In particular, because of low specificity and consequent false-positive diagnoses, and the low percentage of people who “screen positive” that will go onto develop active pulmonary disease, there is significant potential for inappropriate initiation of TB treatment, as well as stigmatisation, loss of livelihoods and in some setting institutionalisation, with uncertain benefit for individual health or community transmission. We use analogy to prompt consideration of how and where new TB screening tests could be implemented in TB screening programmes in low-resource settings. Acceptance and confidence in TB screening programmes depends on well-functioning public health programmes that use screening algorithms that minimise harms and balance population benefits with autonomy and respect for individuals. Before new TB screening tests and algorithms are introduced, more evidence for their effectiveness, costs, benefits and harms under real-world conditions are required.

• Item Type: Articles
• Additional Information: Version 1; peer review: 1 approved, 1 approved with reservations.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter

Creator Roles

MacPherson, P.: Conceptualization, Funding acquisition, Writing – original draft, Writing – review and editing

• Authors: MacPherson, P., Williams, C. M., Burke, R. M., Barer, M. R., and Esmail, H.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Wellcome Open Research
• Publisher: F1000Research
• ISSN: 2398-502X
• ISSN (Online): 2398-502X
• Copyright Holders: Copyright © 2021 MacPherson P et al.
• First Published: First published in Wellcome Open Research 6: 8
• Publisher Policy: Reproduced under a Creative Commons License