Does tuberculosis screening improve individual outcomes? A systematic review

作者：Lily Telisinghe, María Rupérez, Modupe Amofa-Sekyi, Lawrence Mwenge, Tila Mainga, Ramya Kumar, Maged Hassan, Lelia H. Chaisson, Fahd Naufal, Adrienne E. Shapiro, Jonathan E. Golub, Cecily Miller, Elizabeth L. Corbett, Rachael M. Burke, Peter MacPherson, Richard Hayes, Virginia Bond, Cyrus Daneshvar, Eveline Klinkenberg, Helen Ayles · 发表于：EClinicalMedicine · 年份：2021 · DOI：10.1016/j.eclinm.2021.101127 · 被引用次数：41 · 研究领域：Tuberculosis Research and Epidemiology、Diagnosis and treatment of tuberculosis、Pneumonia and Respiratory Infections

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) a...