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Telisinghe, L, Ruperez, M, Amofa-Sekyi, M, Mwenge, L, Mainga, T, Kumar, R, Hassan, M, Chaisson, L.H, Naufal, F, Shapiro, A.E, Golub, J.E, Miller, C, Corbett, E.L, Burke, R.M, MacPherson, Peter 
ORCID: https://orcid.org/0000-0002-0329-9613, Hayes, R.J, Bond, V, Daneshvar, C, Klinkenberg, E and Ayles, H.M
(2021)
'Does tuberculosis screening improve individual outcomes? A systematic review'. EClinicalMedicine, Vol 40, p. 101127.
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Abstract
Background
To determine if tuberculosis (TB) screening improves patient outcomes, we conducted two systematic reviews to investigate the effect of TB screening on diagnosis, treatment outcomes, deaths (clinical review assessing 23 outcome indicators); and patient costs (economic review).
Methods
Pubmed, EMBASE, Scopus and the Cochrane Library were searched between 1/1/1980-13/4/2020 (clinical review) and 1/1/2010-14/8/2020 (economic review). As studies were heterogeneous, data synthesis was narrative.
Findings
Clinical review: of 27,270 articles, 18 (n=3 trials) were eligible. Nine involved general populations. Compared to passive case finding (PCF), studies showed lower smear grade (n=2/3) and time to diagnosis (n=2/3); higher pre-treatment losses to follow-up (screened 23% and 29% vs PCF 15% and 14%; n=2/2); and similar treatment success (range 68-81%; n=4) and case fatality (range 3-11%; n=5) in the screened group. Nine reported on risk groups. Compared to PCF, studies showed lower smear positivity among those culture-confirmed (n=3/4) and time to diagnosis (n=2/2); and similar (range 80-90%; n=2/2) treatment success in the screened group. Case fatality was lower in n=2/3 observational studies; both reported on established screening programmes. A neonatal trial and post-hoc analysis of a household contacts trial found screening was associated with lower all-cause mortality. Economic review: From 2841 articles, six observational studies were eligible. Total costs (n=6) and catastrophic cost prevalence (n=4; range screened 9-45% vs PCF 12-61%) was lower among those screened.
Interpretation
We found very limited patient outcome data. Collecting and reporting this data must be prioritised to inform policy and practice.
Funding
WHO and EDCTP.
| Item Type: | Article |
|---|---|
| Subjects: | WA Public Health > Statistics. Surveys > WA 900 Public health statistics WA Public Health > Statistics. Surveys > WA 950 Theory or methods of medical statistics. Epidemiologic methods WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis |
| Faculty: Department: | Clinical Sciences & International Health > Clinical Sciences Department Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW) |
| Digital Object Identifer (DOI): | https://doi.org/10.1016/j.eclinm.2021.101127 |
| Depositing User: | Stacy Murtagh |
| Date Deposited: | 05 Oct 2021 09:51 |
| Last Modified: | 05 Oct 2021 09:51 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/19085 |
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