Active case-finding of pulmonary TB in an urban emergency department.

The WHO recommends systematic screening of TB in high TB prevalence settings. We evaluated an active case-finding strategy using sputum screening regardless of symptoms in a high TB prevalence Emergency Department (ED) in Peru. This was a cross-sectional study conducted at the Hospital Nacional Dos de Mayo ED, which serves low-income populations in downtown Lima, Peru. Adults presenting to the ED for any reason and able to provide sputum were enrolled. Participants provided one sputum specimen for acid-fast bacilli smear and culture. A second sputum specimen for Xpert MTB/RIF testing was collected if the patient was admitted to an ED observation unit. Between September 2017 and March 2018, 5,171 individuals who presented to the ED were approached. Of 2,119 individuals able to provide sputum, 78 (3.7%) participants had a positive culture and/or Xpert result and were newly diagnosed with TB, whereas traditional screening using >2-week cough identified 41 (1.9%) cases (3.7% vs. 1.9%; < 0.001). Twelve TB cases (15.4%) reported no TB symptoms of any duration. ED-based active case-finding of pulmonary TB using symptom-neutral sputum screening increased TB identification compared to traditional symptom-based screening. Our results align with current WHO recommendation of systematic screening in high TB prevalence areas, which may include ED settings.