Strengthening TB Screening in High-Risk Settings
11 November 2025
Tuberculosis (TB) continues to be one of the world’s leading causes of infectious disease-related illness and death. Despite being treatable, gaps in screening and diagnosis have allowed the disease to persist as a major global health threat. In regions like Southeast Asia, where TB rates remain high, these challenges are particularly pressing.
A new Yale-led study, published in The Lancet Regional Health – Western Pacific, offers evidence for more effective TB screening strategies that could improve detection and outcomes in high-risk populations.
The researchers focused their efforts in Malaysia, a country where tuberculosis incidence has continued to rise over the past decade. The risk of transmission is especially high in prisons, where overcrowding, poor ventilation, and limited access to diagnostic tools make early detection difficult.
“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 in high-risk settings such as prisons helps preserve health, prevent disease progression, and reduce transmission both within and outside of prison walls, Shenoi says. “The prison setting is a unique touchpoint in which to provide care that not only benefits individuals but also protects the broader community,” she adds.
Shenoi notes that better tuberculosis screening in prisons also allows clinicians to detect latent TB infection, a dormant form of the disease that can later become active and contagious. Identifying and treating latent TB is key to breaking the cycle of infection and advancing global TB control.
Researchers compared the performance of several tuberculosis screening methods among more than 500 men entering Kajang Prison, the country’s largest correctional facility.
Typically, TB screening in prisons relies solely on reported symptoms to determine who should receive further testing. In this study, participants underwent both standard symptom screening and additional screening tools, such as chest X-rays and a simple blood test that measured C-reactive protein (CRP), an indicator of inflammation, before confirmatory diagnostic testing was performed.
The researchers found that adding these tools to symptom screening helped flag 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 were more effective at screening for TB among people without HIV, while CRP testing performed better among those living with HIV.
Shenoi hopes these findings will help inform strategies for screening for TB and other infectious diseases in prisons in Malaysia and worldwide. By broadening who gets diagnostic testing, these approaches 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,” Shenoi adds. “They have been excited by this project and are thinking critically about what is feasible to implement in prisons.”
Other Yale authors of the study include Lu Zhang, Frederick Altice, Adeeba Kamarulzaman, Ahmad Ahsan, and Lucian Davis.
Source: Yale School of Medicine
