Our aim is to enable comprehensive discussions on the trade-offs involved for expanded TB screening programs. In this article we describe how false-positive diagnoses are part of TB clinical practice, along with their consequences for individuals, households, health systems, and surveillance data.
Ĭurrent TB policy discussions, program targets, and indicators usually do not consider the risk of false-positive TB diagnoses, despite recognition of the issue in World Health Organization (WHO) recommendations of systematic screening programs.
Similarly, the need for more sensitive diagnostic tools to detect patients earlier in the course of their disease and care-seeking process has been highlighted, but increased sensitivity may come at the cost of reduced specificity. For this reason, national tuberculosis programs are under pressure to expand access to TB screening and diagnosis. To achieve ambitious targets to reduce incidence and deaths due to tuberculosis (TB), global and national policies emphasize the need to diagnose and treat a larger fraction of the 10.4 million individuals who develop TB disease each year. Finally, we suggest practical steps that the TB community can take to reduce the frequency and potential harms of false-positive TB diagnosis and to more explicitly assess the trade-offs involved in the screening and diagnostic process. We then consider the wide range of potential consequences for individuals, households, health systems, and reliability of surveillance data. In this article we describe the pathways to a false-positive TB diagnosis, including trade-offs involved in the development and application of diagnostic algorithms. These false-positive diagnoses have profound consequences for TB patients and prevention efforts, yet are usually overlooked in policy decision making. Together with imperfect performance and application of existing diagnostic tools, including empirical diagnosis, broader screening risks placing individuals without TB on prolonged treatment. To find the millions of missed tuberculosis (TB) cases, national TB programs are under pressure to expand TB disease screening and to target populations with lower disease prevalence.
0 kommentar(er)
