Systematic TB screening using WHO radiograph categorisation and care outcomes.

Area of Science:

• Public Health
• Infectious Diseases
• Radiology

Background:

• Effective tuberculosis (TB) screening and care are vital for prison health programs.
• This study evaluated TB prevalence, screening method accuracy, and treatment outcomes in a Thai correctional facility.

Purpose of the Study:

• To assess the crude prevalence of TB among incarcerated individuals.
• To determine the accuracy of chest X-ray (CXR) categorization and a specific screening questionnaire (TB-P1) for TB detection.
• To evaluate TB treatment outcomes within the prison setting.

Main Methods:

• Retrospective analysis of digital CXR screening data from 2,382 prisoners.
• WHO categorization of CXR findings, followed by sputum microscopy and Xpert testing for eligible cases.
• Utilized a TB-P1 screening questionnaire for case management.

Main Results:

• Crude TB prevalence was 1,133 per 100,000 individuals.
• CXR categorization showed high sensitivity (96.3% for Category 5), while the TB-P1 questionnaire had low sensitivity (22.2%).
• Treatment success rates were 66.7% for drug-susceptible TB and 33.3% for drug-resistant TB.

Conclusions:

• WHO CXR categorization is a viable screening tool for TB in prisons and potentially applicable to artificial intelligence.
• Screening questionnaires (TB-P1) demonstrated limited effectiveness in this prison environment.
• Low treatment success rates highlight ongoing challenges in managing TB within correctional facilities.