A public–private partnership for facility-based tuberculosis screening using chest radiographs, Viet Nam

Objective: To determine tuberculosis prevalence among health-care facility patients and to assess the effectiveness of chest radiography in facility-based tuberculosis screening. Methods: Our cross-sectional analysis used individual-level data collected during 2020-2023 from adults presenting at 796 health-care facilities participating in a public-private partnership in 15 provinces of Viet Nam. We constructed tuberculosis care cascades stratified by symptomatic presentation according to the World Health Organization (WHO) four-symptom screening and chest radiography. We reported diagnostic yield, number needed to screen and positivity. Findings: Among 1 423 818 participants, 22 598 had bacteriologically confirmed tuberculosis. Diagnostic yields were 2.2% (19 289/892 894) among symptomatic individuals with cough, 1.0% (1869/191 677) among symptomatic individuals without cough and 0.4% (1440/339 247) among asymptomatic individuals. Tuberculosis-suggestive chest radiograph results compared with normal results increased bacteriologically confirmed positivity by 9.4 percentage points in symptomatic individuals with cough (17.3%; 18 746/108 650 versus 7.9%; 543/6851), by 4.6 percentage points in symptomatic individuals without cough (12.6%; 1748/13 831 versus 8.0%; 121/1515) and by 7.6 percentage points in asymptomatic individuals (15.0%; 1328/8862 versus 7.4%; 112/1511). Without chest radiography, the number of individuals requiring testing to detect tuberculosis among symptomatic individuals with cough and without a cough would have been 6.5 (1 084 571/165 679) and 5.4 (892 894/165 679) times higher, respectively. Conclusion: Chest radiograph screening can reduce the number of expensive molecular tests used in symptomatic patients and enable tuberculosis diagnosis in asymptomatic patients. Future research should analyse cost and cost-effectiveness of using chest radiography in active and intensified case finding.