Does tuberculosis screening improve individual outcomes? A systematic review

Telisinghe, L. et al. (2021) Does tuberculosis screening improve individual outcomes? A systematic review. EClinicalMedicine, 40, 101127. (doi: 10.1016/j.eclinm.2021.101127) (PMID:34604724) (PMCID:PMC8473670)

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.

• Item Type: Articles
• Additional Information: This work was commissioned by the WHO to update its TB screening guidelines and made possible through a grant from the WHO Global TB Programme. LT, MR, MAS, LM, TM, RK, RJH, VB, EK, HMA are funded by part of the EDCTP2 programme supported by the European Union (grant number RIA2016S-1632-TREATS). RMB, ELC and PM are funded by the Wellcome Trust (203905/Z/16/Z, 200901/Z/16/ Z and 206575/Z/17/Z respectively). AES is supported by an NIH grant K23AI140918.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter
• Authors: 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, P., Hayes, R.J., Bond, V., Daneshvar, C., Klinkenberg, E., and Ayles, H.M.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: EClinicalMedicine
• Publisher: Elsevier
• ISSN: 2589-5370
• ISSN (Online): 2589-5370
• Published Online: 22 September 2021
• Copyright Holders: Copyrightv© 2021 The Author(s)
• First Published: First published in EClinicalMedicine
• Publisher Policy: Reproduced under a Creative Commons licence