Abstract
BackgroundThe World Health Organization (WHO) recommends active case-finding (ACF) of tuberculosis (TB) in certain high-risk groups; however, more evidence is needed to elucidate the scope of ACF beyond the current recommendations. In this study we aimed to systematically review yields (the prevalence of active TB) of studies on ACF in general populations and at-risk groups.
MethodsA literature search in PubMed, Embase and the Cochrane Central Library (CENTRAL) was performed for studies concluded after 31 December 1999 and published before 1 September 2020. Screening yields were estimated and yield/prevalence ratios (ratio between yield of study and WHO estimated prevalence of TB) were calculated to assess which groups might especially benefit from ACF. Finally, risk of bias was assessed and heterogeneity was investigated using meta-regression and sensitivity analyses.
ResultsWe included 197 studies, with a total of 12 372 530 screened and 53 158 cases found. Yields were high among drug users, close contacts, the poor and marginalised, people living with HIV, and prison inmates across incidence strata, and estimated yield/prevalence ratios in screenings of general populations tended to be >1 with an overall ratio of 1.4 and ranging between 1.0 and 1.5. Sensitivity analyses suggested that inclusion of studies at high risk of bias contributed to underestimation of yields.
ConclusionDespite many studies using insensitive screening methods, these results suggest that more at-risk groups should be considered for inclusion in future screening recommendations and that screening of general populations may outperform current case-finding practices, providing evidence for extending ACF beyond the current recommendations.
Abstract
Active case-finding of tuberculosis can produce substantial yields in general populations and at-risk groups and may outperform current case-finding practices. This provides evidence for extending active case-finding beyond current WHO recommendations.http://bit.ly/3lOHVER
Footnotes
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This study is registered atPROSPEROCRD42020206856数量与标识符。
Author contributions: A.S. Bohlbro performed the literature search, extracted and analysed data, and prepared the manuscript. V.S. Hvingelby performed the literature search and extracted data. C. Wejse and F. Rudolf performed supervisory roles. C.B. Patsche was primary supervisor. All authors reviewed the manuscript prior to submission.
Conflict of interest: A.S. Bohlbro has nothing to disclose.
Conflict of interest: V.S. Hvingelby has nothing to disclose.
Conflict of interest: F. Rudolf has nothing to disclose.
Conflict of interest: C. Wejse has nothing to disclose.
Conflict of interest: C.B. Patsche has nothing to disclose.
Support statement: The study was funded by a grant from the Aarhus University Research Foundation. Funding information for this article has been deposited with theCrossref Funder Registry.
- ReceivedJanuary 11, 2021.
- AcceptedMarch 14, 2021.
- Copyright ©The authors 2021. For reproduction rights and permissions contactpermissions{at}ersnet.org