Screening Flowchart: Figure 2

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Tuberculosis Screening for Applicants in High Tuberculosis Burden Countries*

1. If “Tuberculosis Screening for applicants <2 years of age in high-burden countries”, then
   1. If “For all applicants <2 years of age”, then
      1. “Medical history”
      2. “Physical examination”
   2. If “For those with signs or symptoms of tuberculosis or known HIV infection”, then
      1. “IGRA or TST”
      2. “Chest x-ray”
      3. “Three sputum specimens for smears and culture plus molecular testing of the first specimen”
   3. If “For those with positive cultures”, then
      1. “Drug susceptibility testing”
2. If “Tuberculosis screening for applicants ≥ 2 years of age in high-burden countries”, then
   1. If “For all applicants ≥2 years of age countries”, then
      1. “Medical history”
      2. “Physical examination”
      3. “IGRA”
   2. If “Chest x-ray required for:” then
      1. ”All applicants ≥15 years of age regardless of IGRA result”
      2. “Those <15 years of age with a positive IGRA, or signs or symptoms of tuberculosis, or known HIV infection”
   3. If “For those with a chest x-ray suggestive of tuberculosis, or signs or symptoms of tuberculosis, or known HIV infection”, then
      1. Three sputum specimens for smears and culture plus molecular testing of the first specimen
   4. If “For those with positive cultures”, then
      1. “Drug susceptibility testing”

*Countries with a World Health Organization-estimated tuberculosis disease incidence rate ≥20 cases per 100,000 population.

IGRA = Interferon-gamma release assay

TST = Tuberculin skin test