Routine TB screening (intensified case finding)

Clinical description

• Screen all patients at each visit for signs of active TB using 4 standard screening questions

o Cough of any duration o Fever o Night sweats o Weight loss / failure to thrive / malnutrition

• Children: in addition to the above, ask about the following signs. Investigate for TB if any are

present:

o Unresolved pneumonia o Frequent hospitalization/ illness o TB contact Continuing ART

• Classify screening outcome as follows:

o TB not suspected if none of the 4 signs are positive. In this case, the patient is very unlikely to have active TB.

o TB presumptive if one or several of the 4 signs are positive.

• Thoroughly investigate further (full clinical exam, sputum for Xpert, chest x-ray, fine

needle aspirate, TB urine Lam if indicated, FASH, etc.)

• Interrupt TPT until active TB has been ruled out

o TB confirmed if the patient has a current confirmed episode of TB (clinical or lab diagnosis).

• Always confirm if the patient is currently taking and adherent to TB treatment –

initiate TB treatment without delay or provide intensive adherence support.

• Classify on TB treatment or not on treatment.