Programmatic approaches to screening for tuberculosis disease: a situational analysis of seven countries in the...

Tuberculosis (TB) remains a significant public health challenge in the Western Pacific Region, which accounts for approximately 20% of the global TB burden. Despite effective diagnostic tools and treatment, many individuals with TB remain undiagnosed or unreported, particularly in high-burden countries. Systematic screening is a key strategy for identifying cases early and reducing transmission. This study presents a situational analysis of TB screening policies, practices, and challenges across seven high-burden countries in the region: Cambodia, China, Lao PDR, Mongolia, Papua New Guinea, the Philippines, and Viet Nam.

Data were collected through questionnaires, follow-up discussions, and a regional workshop involving National TB Programme representatives and WHO staff. Most countries have national guidelines for systematic screening, prioritising high-risk groups, like people living with HIV and household contacts. Common screening tools include symptom screening, chest X-rays, and WHO-recommended rapid molecular diagnostics. Although asymptomatic TB is increasingly recognised, symptom screening remains the primary initial tool. Chest X-rays with computer-aided detection technologies are available in most countries, but are often limited to donor-funded projects. Screening is conducted through routine healthcare visits, scheduled checks for specific populations (e.g., prisoners, older adults), and ad hoc campaigns. Implementation varies due to resource and infrastructure limitations. While integration with other health services and community-based approaches shows promise, these remain underutilised. Key challenges include limited funding, workforce shortages, low provider awareness, and stigma. The COVID-19 pandemic disrupted TB services, underscoring the need for resilient health systems.

Improving systematic TB screening requires scaling up sensitive diagnostic tools, decentralising implementation, and strengthening community engagement. Sustainable financing, robust health systems, and multi-sectoral collaboration are critical to reaching the "missing millions" and achieving the End TB goals. This analysis underscores the need for targeted, evidence-based strategies to enhance screening coverage and effectiveness across diverse epidemiological and resource settings.