Tuberculosis Screening During Pregnancy: A Systematic Review of Policies, Practices, and Perceptions Across Global Settings.

Tuberculosis (TB) remains a leading infectious disease threatening maternal and neonatal health, especially in low- and middle-income countries. Although WHO promotes integrating screening into antenatal care, implementation across countries remains inconsistent and often insufficient. In Indonesia, TB screening is a critical component of antenatal care due to the high prevalence. This systematic literature review aimed to synthesize global evidence on TB screening among pregnant women, with a focus on policies, practices, and implementation challenges, particularly within the Indonesian context. Following PRISMA 2020 and Joanna Briggs Institute guidelines, a comprehensive search was conducted across PubMed and Scopus. Studies published between 2010 and 2025 were included. Ten eligible studies with diverse methodologies were identified, ranging from policy reviews to behavioral and epidemiological analyses. Results showed that only 64% of countries included TB screening for pregnant or breastfeeding women in their policies. Most low-middle income countries also still rely on symptom-based screening rather than advanced diagnostics such as interferon-gamma release assays (IGRA) or Quantiferon testing. Behavioral factors, stigma, and limited health infrastructure further reduce screening uptake. In Indonesia, TB screening during pregnancy remains sporadic and poorly integrated into maternal health services. This review highlights the urgent need for context-specific screening models, stronger policy alignment, and better integration of TB and maternal health programs to improve early detection and reduce the burden of maternal TB.