Artificial Intelligence for Tuberculosis Screening and Detection: From Evidence to Policy and Implementation.

Artificial intelligence (AI) is increasingly used to support tuberculosis (TB) screening and diagnosis, particularly through computer-aided detection (CAD) applied to chest radiography (CXR). However, the programmatic value of AI depends not only on diagnostic accuracy but also on implementation context, threshold calibration, and integration into diagnostic pathways. We conducted a narrative, state-of-the-art review of AI applications across the TB diagnosis pathway. Evidence was synthesized from World Health Organization policy documents, independent validation initiatives, and peer-reviewed studies published between 2010 and 2026, with a structured selection process aligned with PRISMA principles. CAD for CXR is the most mature AI application and is recommended by WHO for TB screening and triage among individuals aged ≥15 years in specific contexts. Across studies, CAD-CXR demonstrates sensitivity comparable to human readers, although performance varies by product, population, and imaging conditions, necessitating local threshold calibration. Evidence from implementation studies suggests improvements in screening efficiency and potential cost-effectiveness in high-burden settings. Other AI modalities, including computed tomography (CT)-based imaging analysis, point-of-care ultrasound interpretation, cough or stethoscope sound analysis, clinical risk models, and genomic resistance prediction show promising but heterogeneous results, with most requiring further independent validation and prospective evaluation. AI has the potential to strengthen TB screening and diagnostic pathways, but its impact depends on integration into health systems and evaluated using patient- and program-level outcomes rather than accuracy alone. A differentiated approach is needed, with responsible scale-up of policy-endorsed tools alongside rigorous evaluation of emerging technologies to support effective and equitable TB care.