Introduction
TB, TUTT
DISEASE, TUBERCULOSIS (TB)
The World Health Organization’s (WHO) 2020 Global Tuberculosis (TB) Report highlighted the gap between the number of new patients diagnosed with TB worldwide (7.1 million) and the estimate of total incident cases (10 million) [Passive case finding, which relies on people with symptoms of TB presenting themselves to the health system, does not identify the majority of missing TB patients [We did not conduct a formal review of prior research into finding missing patients. There are 3 recent reviews of existing data directed at finding missing TB patients, one of which assessed cost effectiveness; all conclude that in high-risk groups, Xpert testing could be included as a screening tool [We posited that there were patients who did not report TB symptoms for some reason, or that they did not have TB symptoms that could be elicited by routine screening, or they did have symptoms but these were not detected or responded to by the health system. Although there are multiple groups at high risk for TB disease [We therefore hypothesized that targeting high-risk groups for universal TB testing, irrespective of whether they report symptoms or not, would identify additional patients with TB. We conducted a cluster-randomized trial of targeted universal testing for TB (TUTT) for clinic attendees in these 3 high-risk groups to ascertain whether more patients were diagnosed with TB every month in those clinics randomized to TUTT than in the control clinics.