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

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.

Social profile of tuberculosis in urban area

Background. Tuberculosis is an infectious socially significant disease. Apart from individual traits of the disease pathology, drug sensitivity and the availability of effective medicine and prevention, an important factor of its control is the patient’s social status. Social patient profiling in various locations across the country is vital for developing and deploying a high-quality and feasible tuberculosis care programme.Objectives. Social profiling of tuberculosis in St. Petersburg as an example of large urban area. Methods. We developed a questionnaire to assess 40 social parameters of a patient with tuberculosis. The study sample was representative and surveyed 666 (63.4%) and 704 (65.7%) patients with primary diagnosis in 2017 and 2018, respectively.Results. The survey showed almost no impact of external migration on tuberculosis epidemiology in St. Petersburg. Internal migrants counted 76 (11.4%) in 2017 and 96 (13.4%) in 2018, thus suggesting the majority of primary tuberculosis patients being permanent residents of St. Petersburg. The contribution of individuals with no fixed abode to the incidence rate was also insignificant, 2.4% and 1.9%. Most patients were unemployed people of working age, 236 (35.4%) in 2017, 261 (37.1%) in 2018. Incidence among students as a younger population was lowest, 2.1% and 2.8%. Smokers accounted for half of total patients, 370 (55.6%) and 368 (52.3%). One in five patients carried HIV infection, with half of them not receiving antiretroviral therapy. Patients with unfinished secondary education and residing in collective dwellings were significantly more frequent, whilst the proportion of persons with high income decreased. Over half of the patients had no family at primary diagnosis, and over a third had never been married.Conclusion. The social profile of primary tuberculosis in an urban area is as follows: single man, near 40 years old, permanent resident, unemployed, working-age, smoker, resides in private abode, has secondary or secondary vocational education, low to average income.