{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T12:47:56Z","timestamp":1785847676250,"version":"3.56.0"},"reference-count":33,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"unspecified","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"India Department of Biotechnology"},{"name":"Gupta-Klinsky India Institute \/ Koita Centre for Digital Health"},{"name":"Civilian Research & Development Foundation (CRDF) Global"},{"DOI":"10.13039\/100015691","name":"Division of Microbiology and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI097494"],"award-info":[{"award-number":["R01AI097494"]}],"id":[{"id":"10.13039\/100015691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015691","name":"Division of Microbiology and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI143748"],"award-info":[{"award-number":["R01AI143748"]}],"id":[{"id":"10.13039\/100015691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006084","name":"Office of AIDS Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006084","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2026,7,20]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>People recently treated for tuberculosis (TB) (TB survivors) face substantial risk of recurrence. The optimal implementation and expected impact of active case-finding are uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed an individual-level stochastic simulation model of TB recurrence among recently treated people in India, informed by empirical data on the cumulative incidence and timing of TB recurrence, the extent and durations of symptoms and bacteriological positivity and screening-related costs. We modelled post-treatment symptom screening at quarterly or semiannual intervals, with or without universal near-point-of-care bacteriological testing at the first screening encounter. We estimated months of symptomatic TB and of potentially infectious (bacteriologically positive, regardless of symptom status) TB averted over a 2-year period after treatment, along with corresponding screening programme costs, estimated as medians and 95% uncertainty ranges across simulations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Symptomatic TB recurred within 2 years post-treatment in 10% (8%\u201312%) of recent TB survivors and undiagnosed prevalence peaked in month 2 (1\u20133). Symptom screening 6, 12 and 18 months post-treatment (as per Indian guidelines) averted 16% (8%\u201332%) of symptomatic and 8% (5%\u201317%) of infectious time. An \u2018early\u2019 screening schedule (3, 6 and 9 months post-treatment) increased case detection and health impact (26% (15%\u201343%) of symptomatic and 16% (9%\u201327%) of infectious time averted). Adding \u2018universal bacteriologic testing\u2019 at the 3-month encounter doubled the impact on transmission potential (34% (21%\u201355%) of symptomatic and 37% (22%\u201362%) of infectious time averted). In this context, \u2018early\u2019 symptom screening cost $190 ($100\u2013$350) per case detected, and adding universal bacteriological testing cost an additional $520 ($240\u2013$1070) per case incrementally detected by the screening programme.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Screening for recurrent TB in high-risk settings such as India could reduce morbidity and time spent with potentially infectious TB. Concentrating screening within the first year has greatest yield. Symptom-based screening is most affordable, but testing for asymptomatic recurrence could further reduce transmission potential.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2026-024146","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T12:10:13Z","timestamp":1785845413000},"page":"e024146","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Optimising screening for recurrent tuberculosis: a microsimulation-based study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0083-422X","authenticated-orcid":false,"given":"Emily A","family":"Kendall","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samyra R","family":"Cox","sequence":"additional","affiliation":[{"name":"International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhay","family":"Kadam","sequence":"additional","affiliation":[{"name":"Center for Infectious Diseases in India, Johns Hopkins India, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1970-0174","authenticated-orcid":false,"given":"Aye Hnin","family":"Moe","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayatri","family":"Lele","sequence":"additional","affiliation":[{"name":"Center for Infectious Diseases in India, Johns Hopkins India, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6688-2478","authenticated-orcid":false,"given":"Nikhil","family":"Gupte","sequence":"additional","affiliation":[{"name":"Center for Infectious Diseases in India, Johns Hopkins India, Pune, Maharashtra, India"},{"name":"Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhusudan","family":"Barthwal","sequence":"additional","affiliation":[{"name":"Dr. D.Y. Patil Medical College, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9843-4656","authenticated-orcid":false,"given":"Mandar S","family":"Paradkar","sequence":"additional","affiliation":[{"name":"Center for Infectious Diseases in India, Johns Hopkins India, Pune, Maharashtra, India"},{"name":"Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mithun K","family":"Mitra","sequence":"additional","affiliation":[{"name":"Department of Physics, Indian Institute of Technology Bombay, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hojoon","family":"Sohn","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Seoul National University College of Medicine, Jongno-gu, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreeya","family":"Wasunkar","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Seoul National University College of Medicine, Jongno-gu, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6965-7770","authenticated-orcid":false,"given":"Ryan R","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7036-2718","authenticated-orcid":false,"given":"Amita","family":"Gupta","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Gaikwad","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan E","family":"Golub","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8509-4517","authenticated-orcid":false,"given":"Vidya","family":"Mave","sequence":"additional","affiliation":[{"name":"Center for Infectious Diseases in India, Johns Hopkins India, Pune, Maharashtra, India"},{"name":"Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"2026080405100552000_11.8.e024146.1","unstructured":"World Health Organization . 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Copenhagen, Denmark, 2025."},{"key":"2026080405100552000_11.8.e024146.4","doi-asserted-by":"crossref","first-page":"55","DOI":"10.4103\/jacp.jacp_22_22","article-title":"National TB Elimination Program (NTEP)","volume":"10","author":"Kundu","year":"2022","journal-title":"J Assoc Chest Physicians"},{"key":"2026080405100552000_11.8.e024146.5","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-022-06503-6","article-title":"Tuberculosis (TB) Aftermath: study protocol for a hybrid type I effectiveness-implementation non-inferiority randomized trial in India comparing two active case finding (ACF) strategies among individuals treated for TB and their household contacts","volume":"23","author":"Cox","year":"2022","journal-title":"Trials"},{"key":"2026080405100552000_11.8.e024146.6","doi-asserted-by":"crossref","unstructured":"Cox SR , Kadam A , Valawalkar S , et al . Phone screening compared to home-based screening post tuberculosis in india (tb aftermath): a non-inferiority, randomized trial. SSRN [Preprint] 2025. doi:10.2139\/ssrn.5817293","DOI":"10.2139\/ssrn.5817293"},{"key":"2026080405100552000_11.8.e024146.7","doi-asserted-by":"crossref","first-page":"e612","DOI":"10.1093\/cid\/ciaf353","article-title":"A Point-of-Care Prediction Tool for Recurrent Tuberculosis","volume":"81","author":"Cox","year":"2026","journal-title":"Clin Infect Dis"},{"key":"2026080405100552000_11.8.e024146.8","unstructured":"Gaikwad S . Timing of asymptomatic and symptomatic tuberculosis recurrence diagnoses after successful tuberculosis treatment completion in India. Union World Conference on Lung Health 2025, Copenhagen; 2025"},{"key":"2026080405100552000_11.8.e024146.9","doi-asserted-by":"crossref","DOI":"10.3389\/ftubr.2024.1433975","article-title":"Clinical and laboratory risk factors for pulmonary tuberculosis recurrence in three pooled Indian cohorts","volume":"2","author":"Krishnan","year":"2024","journal-title":"Front Tuberc"},{"key":"2026080405100552000_11.8.e024146.10","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-019-7026-4","article-title":"Empirical evidence of delays in diagnosis and treatment of pulmonary tuberculosis: systematic review and meta-regression analysis","volume":"19","author":"Bello","year":"2019","journal-title":"BMC Public Health"},{"key":"2026080405100552000_11.8.e024146.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-021-02128-9","article-title":"Durations of asymptomatic, symptomatic, and care-seeking phases of tuberculosis disease with a Bayesian analysis of prevalence survey and notification data","volume":"19","author":"Ku","year":"2021","journal-title":"BMC Med"},{"key":"2026080405100552000_11.8.e024146.12","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-010542","article-title":"Cohort for Tuberculosis Research by the Indo-US Medical Partnership (CTRIUMPH): protocol for a multicentric prospective observational study","volume":"6","author":"Gupte","year":"2016","journal-title":"BMJ Open"},{"key":"2026080405100552000_11.8.e024146.13","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.17.0474"},{"key":"2026080405100552000_11.8.e024146.14","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0294254","article-title":"Recurrence of pulmonary tuberculosis in India: Findings from the 2019-2021 nationwide community-based TB prevalence survey","volume":"18","author":"Giridharan","year":"2023","journal-title":"PLoS One"},{"key":"2026080405100552000_11.8.e024146.15","article-title":"Xpert MTB\/RIF Ultra assay for pulmonary tuberculosis and rifampicin resistance in adults and adolescents","volume":"7","author":"Horne","year":"2025","journal-title":"Cochrane Database Syst Rev"},{"key":"2026080405100552000_11.8.e024146.16","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciad595"},{"key":"2026080405100552000_11.8.e024146.17","unstructured":"World Heatlh Organization . 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Finding TB post-treatment in India: cost-effectiveness of phone compared to home-based screening. 2025."},{"key":"2026080405100552000_11.8.e024146.20","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0005364","article-title":"Early cost-effectiveness analysis of a novel rapid diagnostic test for tuberculosis in rural Philippine settings","volume":"5","author":"Sargood","year":"2025","journal-title":"PLOS Glob Public Health"},{"key":"2026080405100552000_11.8.e024146.21","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1093\/cid\/ciaf389","article-title":"Sputum and Tongue Swab Molecular Testing for the In-Home Diagnosis of Tuberculosis in Unselected Household Contacts: A Cost and Cost-Effectiveness Analysis","volume":"82","author":"Bezuidenhout","year":"2026","journal-title":"Clin Infect Dis"},{"key":"2026080405100552000_11.8.e024146.22","doi-asserted-by":"crossref","unstructured":"Barrameda AJD , Papadopoulou P , Yu C , et al . 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UCSF\u2019s risk stratification tool for tuberculosis clinical trial design."},{"key":"2026080405100552000_11.8.e024146.26","unstructured":"Stop TB Partnership . Global drug facility product catalogue. 2025."},{"key":"2026080405100552000_11.8.e024146.27","doi-asserted-by":"crossref","first-page":"e995","DOI":"10.1016\/S2214-109X(24)00088-3","article-title":"Economic implications of novel regimens for tuberculosis treatment in three high-burden countries: a modelling analysis","volume":"12","author":"Ryckman","year":"2024","journal-title":"Lancet Glob Health"},{"key":"2026080405100552000_11.8.e024146.28","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.5588\/ijtld.21.0105","article-title":"Costs of TB services in India (No 1)","volume":"25","author":"Chatterjee","year":"2021","journal-title":"Int J Tuberc Lung Dis"},{"key":"2026080405100552000_11.8.e024146.29","doi-asserted-by":"crossref","unstructured":"Steadman A , Kumar KM , Asege L , et al . 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