Tuberculosis (TB) is a leading cause of global morbidity and mortality, despite being preventable [1]. Ending TB is a global priority, as evident by the existence of the World Health Organisation (WHO) End Tuberculosis Strategy [2], which includes a target of a 90% reduction in TB incidence by 2035 (compared with 2015). As well as collaborating globally to achieve this target, the strategy requires all countries to adapt it at a national level. In 2020, there were 57 countries with a low incidence of TB (defined as fewer than 10 cases per 100,000) [1] that, as well as aiming to achieve the End TB Strategy targets, should be aiming to eliminate TB (defined as fewer than 1 case per million) [3], an important step in global aspirations to end the disease. TB in low-incidence countries is characterised by most disease (70–80%) being due to TB reactivation rather than recent transmission [4,5]. Therefore, identifying latent tuberculosis infection (LTBI) among population groups with a high prevalence or risk of reactivation and providing them with preventive care is important to achieve TB elimination in low-incidence countries [3]. Preventive care involves reducing risk factors for TB reactivation, such as smoking or excessive alcohol intake [6], but also providing chemoprophylactic treatment, which is highly effective [7,8].

Ireland is a high-income European country with a low incidence of TB (5.6 cases per 100,000 in 2019), drug-resistant TB, and human immunodeficiency virus (HIV)/TB coinfection [9]. The incidence of TB is declining, and deaths due to TB are infrequent [9]. Despite being well placed to eliminate TB, Ireland is not on target to do so [3]. The European Centre for Disease Prevention and Control recommend that low-incidence European countries, such as Ireland, programmatically screen and treat those at-risk of TB for LTBI [6]. At a minimum, this includes people living with HIV; immunosuppressed persons (such as patients on anti-tumour necrosis factor alpha treatment); patients preparing for transplantation; patients with end-stage renal diseases or preparing for dialysis; patients with silicosis; people with pulmonary fibrotic lesions; and contacts of infectious TB cases (based on a risk assessment of their exposure) [3,6]. In Ireland, TB care is primarily provided by specialists in tertiary centres and regional public health departments. There is no national programmatic approach to LTBI.

If the programmatic management of LTBI is to be an effective approach to eliminating TB in low-incidence countries, then LTBI screening must be of high quality to maximise those at-risk of TB identified for screening who would subsequently benefit from completing preventive treatment [10]. Therefore, evaluations that define, measure, and report screening quality are important. Such evaluations should be performed nationally to be informative for programmatic LTBI management, but also locally to be informative for local service provision [10]. Where deficits in screening quality are identified, health care providers can engage with their patients to understand why, and service quality can be improved. In Ireland, evaluations of LTBI screening are lacking across all at-risk groups, even at a local level [11]. There is a need for LTBI screening evaluations to be performed at service and national levels in Ireland. Without these, or any progress in establishing programmatic LTBI care, TB elimination efforts in Ireland will remain off track.

To evaluate quality, it is necessary to apply a framework that defines quality and outlines how it can be measured. A widely used framework for assessing quality is that of the Institute of Medicine [12], which has been adapted by the WHO and used in their framework for quality, as described in Delivering quality health services: a global imperative for universal health [13]. According to the Institute of Medicine, quality of care is defined as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” [12] and can be measured according to six domains; effectiveness, efficiency, equity, timeliness, patient-centredness, and safety (integration was also added to the Institute of Medicine framework by the WHO in their adaptation).

2. Description of Cohort Screened

3. Screening Effectiveness

4. Screening Efficiency

5. Equity of Care