High-risk groups — MSF Tuberculosis — Médecins Sans Frontières 2026

MSFClinical guideline (chapter)Current edition

From Tuberculosis › Chapter 6: Screening for active tuberculosis · Médecins Sans Frontières, Current online edition, 2026

Identifies priority populations for active TB screening including contacts, HIV-infected patients and other vulnerable groups.

In one sentenceScreen all contacts of bacteriologically confirmed pulmonary TB; screen HIV-infected patients at every health contact; routinely screen detained persons and silica-exposed workers; consider screening based on local TB prevalence thresholds.

Issuer: Médecins Sans Frontières
Edition: Current online edition, 2026
Audience: Clinicians and public health professionals managing tuberculosis screening programmes
Evidence: Based on WHO operational handbooks and consolidated guidelines
Reviewed: 22 Oct 2026 · GMJ

Read the original on MSF Whole guideline (PDF)

Summary by GMJ Guidelines Desk•Reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD•Record updated 22 Oct 2026•Next check Apr 2027

What this guideline says

GMJ summary

This section of the MSF tuberculosis guideline defines high-risk populations requiring systematic screening for active tuberculosis. The guidance prioritises three major groups: contacts of TB patients (household and close contacts as defined by WHO), HIV-infected patients (both outpatients and inpatients), and other vulnerable populations including detained persons, miners with silica exposure, and patients with silicosis.

For contacts, screening intensity depends on whether the index patient has bacteriologically confirmed pulmonary TB (all contacts screened) or clinically diagnosed/extrapulmonary TB (contacts under 15 years or with HIV screened). HIV-infected outpatients should be screened at every health worker contact using age-appropriate tools: the WHO four-symptom screen (W4SS) for adolescents and adults, and symptom presence or contact history for children. HIV-infected inpatients warrant upfront diagnostic testing with lateral flow urine lipoarabinomannan assay and rapid molecular tests.

Additional populations for routine or context-dependent screening include miners and persons with silica exposure, detained persons, patients with malnutrition or chronic diseases (diabetes, COPD), pregnant women, healthcare staff exposed to TB, urban slum dwellers, migrants from countries with TB prevalence ≥100/100,000, and general populations in areas with TB prevalence ≥500/100,000.

Key points

For clinicians — doses and thresholds as stated in the guideline

Screen all household and close contacts rapidly if the index patient has bacteriologically confirmed pulmonary TB, regardless of age or HIV status
If index patient has clinically diagnosed pulmonary TB or extrapulmonary TB, screen household and close contacts under 15 years and/or with HIV infection
Household contacts share the same enclosed living space for one or more nights or frequent/extended daytime periods with the index case during the 3 months before treatment start
Screen HIV-infected outpatients for active TB at each contact with trained health workers; use W4SS for adolescents and adults, symptom/contact history for children
Perform upfront diagnostic testing (lateral flow urine lipoarabinomannan assay and rapid molecular tests) in HIV-infected inpatients
Routinely screen detained persons and miners/persons with current or past silica exposure and patients with silicosis for active TB
Consider screening migrants from countries with TB prevalence ≥100/100,000 and general populations in areas with TB prevalence ≥500/100,000
Context-dependent screening includes pregnant women, patients with malnutrition or chronic diseases (diabetes, COPD), persons over 60 years, and those previously treated for TB

From the guideline

Verbatim

“In HIV-infected outpatients, screening for active TB should be performed at each contact with a trained health worker (e.g. counsellor, nurse).”

— Médecins Sans Frontières, High-risk groups — MSF Tuberculosis, Section 6.2.2 (2026)

Editor’s perspective

Why this matters for Georgia and the region

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration

As someone who has worked extensively on TB control in the South Caucasus, I recognise that this MSF guidance addresses critical gaps in our regional screening practices. The recommendation to screen all household contacts of bacteriologically confirmed pulmonary TB cases and to integrate TB screening at every HIV care encounter are achievable priorities for Georgia's national programme, particularly given our existing infrastructure for contact tracing and the integration of TB and HIV services. The guidance on screening migrants from countries with TB prevalence ≥100/100,000 is particularly relevant for Georgia given population movements within the region, though implementation will require coordination between border health services, primary care facilities and the national TB programme. The pragmatic tiering of screening recommendations—distinguishing routine from context-dependent screening—allows resource-constrained settings to prioritise the highest-yield populations while scaling up as capacity permits.

ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 22 Oct 2026

Applicability

Georgia and the South Caucasus

For Georgia and the South Caucasus, this guidance is highly relevant given the region’s tuberculosis burden and specific vulnerabilities. Georgia’s national TB programme should prioritise systematic contact tracing, particularly in household settings, and ensure integration of TB screening into HIV care services. The guidance on screening migrants from high-prevalence countries (≥100/100,000) and vulnerable populations in urban settings applies to internal migrants and refugees in the region. Implementation will require strengthening links between TB and HIV services, establishing screening protocols in detention facilities, and addressing occupational health in mining communities. National programmes must adapt the optional screening categories based on local epidemiology, resource availability, and the capacity of primary health care to deliver systematic screening.

Questions this guideline answers

Quick answers

Who qualifies as a household contact requiring TB screening?

A household contact is someone who shared the same enclosed living space with the index TB case for one or more nights or for frequent or extended daytime periods during the 3 months before the index patient started treatment.

Should all contacts be screened if the index patient has extrapulmonary TB only?

If the index patient has clinically diagnosed pulmonary TB or extrapulmonary TB, screening should be performed in household and close contacts under 15 years and/or with HIV infection. Screening can be extended to all contacts depending on resources and national recommendations.

How frequently should HIV-infected patients be screened for TB?

HIV-infected outpatients should be screened for active TB at each contact with a trained health worker (counsellor, nurse). For adolescents and adults, use the WHO four-symptom screen; for children, base screening on symptoms and/or contact history with a TB patient.

At what TB prevalence threshold should screening be considered for the general population?

General population screening can be considered in areas with a TB prevalence estimated to be 500/100,000 or higher, depending on local epidemiology, context and resources. Migrants from countries with TB prevalence of 100/100,000 or higher can also be considered for screening.

Related on GMJ

Interconnected resources

Dictionary of Public Health

Conditions A–Z

GMJ News coverage

Quality & accreditation

Same guideline

MSF Tuberculosis: Chapter 6.1 Introduction — Screening for active tuberculosis — MSF TuberculosisChapter 6: Screening for active tuberculosis
Guidance for using diagnostic algorithm for pulmonary tuberculosis — MSF TuberculosisChapter 5: Diagnostic algorithm for pulmonary tuberculosis in symptomatic adolescents and adults
Diagnostic approach — MSF TuberculosisChapter 4: Diagnosis of active tuberculosis in children
Diagnosis of Active Tuberculosis in Children: Introduction — MSF TuberculosisChapter 4: Diagnosis of active tuberculosis in children
Other investigations — MSF TuberculosisChapter 3: Diagnosis and follow-up investigations
Latent tuberculosis infection — MSF TuberculosisChapter 3: Diagnosis and follow-up investigations

High-risk groups — MSF Tuberculosis

What this guideline says

Key points

From the guideline