Strengthening tuberculosis screening in high-risk settings

Tuberculosis (TB) remains a leading global cause of infectious disease-related illness and death. Gaps in screening and diagnosis hinder effective treatment, allowing TB to persist as a major health threat, particularly in regions like Southeast Asia with high TB rates.

A new Yale-led study, published in The Lancet Regional Health—Western Pacific, presents evidence supporting more effective TB screening strategies. These strategies could significantly improve TB detection and outcomes in high-risk populations.

Focus on Malaysian Prisons

Researchers concentrated their efforts in Malaysia, where tuberculosis incidence has risen over the past decade. Prisons present a particularly high risk of TB transmission due to overcrowding, poor ventilation, and limited access to diagnostic tools, making early detection challenging.

"Globally, there are multiple gaps in health care among people in prison," says Sheela Shenoi, MD, senior author of the study and associate professor of medicine (infectious diseases) at Yale School of Medicine. Expanding access to timely diagnosis and treatment helps preserve health, prevent disease progression, and reduce transmission within and outside prison walls.

Dr. Shenoi emphasizes that improved TB screening in prisons allows clinicians to detect latent TB infection. Identifying and treating latent TB is crucial for breaking the cycle of infection and advancing global TB control.

Comparing Screening Methods

Researchers compared the effectiveness of several tuberculosis screening methods among over 500 men entering Kajang Prison, Malaysia's largest correctional facility. Traditionally, TB screening in prisons relies solely on reported symptoms to determine who needs further testing.

In this study, participants underwent standard symptom screening in addition to chest X-rays and a blood test measuring C-reactive protein (CRP), an inflammation indicator. The researchers found that these additional tools helped identify individuals who would have otherwise gone untested for TB.

The study also revealed that the most effective approach varied based on comorbid conditions such as HIV. Chest X-rays proved more effective for screening TB among people without HIV, while CRP testing performed better among those living with HIV.

Dr. Shenoi hopes these findings will inform strategies for screening for TB and other infectious diseases in prisons in Malaysia and worldwide. Broadening diagnostic testing could uncover more hidden cases of TB and strengthen efforts to control its spread in high-risk settings.

"We have had very productive discussions with the Malaysian Ministry of Health, who have partnered with us in this work," Dr. Shenoi adds. "They have been excited by this project and are thinking critically about what is feasible to implement in prisons."

More information: Lu Zhang et al, Screening and diagnostic strategies for active pulmonary tuberculosis among people in prison in Malaysia: a prospective diagnostic study, The Lancet Regional Health - Western Pacific (2025). DOI: 10.1016/j.lanwpc.2025.101712