Approximately half of microbiologically diagnosed TB cases in the elderly population were asymptomatic, underscoring the critical need for active case finding. Tongue swab screening detected 77.8% of TB cases at a cost of $24,958.06 per case, given its cost-effectiveness relative to the local GDP. Extrapolating our findings, we observed five and two microbiologically diagnosed TB cases in two specific districts, corresponding to incidence rates of 29.15 (95%CI 10.7–72.3) and 14.99 (95%CI 2.6–60.5) per 100,000 population, suggesting that the true burden of TB in these areas may be underestimated. The potential of tongue swab screening in economically developed, low-burden settings, particularly among asymptomatic elderly populations, remains to be further explored for broader implementation.

PAR significantly decreased after anti-TB treatment. The risk score based on baseline RAR, pulmonary radiology and sputum smear could identify patients at high risk of delayed culture conversion.

A higher incidence of neutropenia was observed in rifapentine 15mg/kg arm, emphasizing the importance of close monitoring of CBC among patients receiving high dose rifapentine.

AI-based CXR missed 50% of these asymptomatic cases. Our findings provide critical insights into the potential of tongue swab-based screening, highlighting its diagnostic accuracy and utility, particularly in asymptomatic populations. Further validation in diverse populations is warranted.