Tuberculosis screening among HIV-positive inpatients:a systematic review and individual participant data meta-analysis

作者：Ashar Dhana, Yohhei Hamada, André Pascal Kengne, Andrew D. Kerkhoff, Molebogeng X. Rangaka, Tamara Kredo, Annabel Baddeley, Cecily Miller, Ankur Gupta‐Wright, Katherine Fielding, Robin Wood, Helena Huerga, Sekai Chenai Mathabire Rücker, Christine Heidebrecht, Douglas Wilson, Stephanie Bjerrum, Işık Somuncu Johansen, Swe Swe Thit, Mar Mar Kyi, Josh Hanson, David Barr, Graeme Meintjes, Gary Maartens, Ashar Dhana, Yohhei Hamada, André Pascal Kengne, Andrew D. Kerkhoff, Molebogeng X. Rangaka, Tamara Kredo, Annabel Baddeley, Cecily Miller, Ankur Gupta‐Wright, Katherine Fielding, Robin Wood, Helena Huerga, Sekai Chenai Mathabire Rücker, Christine Heidebrecht, Douglas Wilson, Stephanie Bjerrum, Işık Somuncu Johansen, Swe Swe Thit, Mar Mar Kyi, Josh Hanson, David Barr, Graeme Meintjes, Gary Maartens · 发表于：UCL Discovery (University College London) · 年份：2022 · 被引用次数：30 · 研究领域：Diagnosis and treatment of tuberculosis、Tuberculosis Research and Epidemiology、Mycobacterium research and diagnosis

BACKGROUND: Since 2011, WHO has recommended that HIV-positive inpatients be routinely screened for tuberculosis with the WHO four-symptom screen (W4SS) and, if screened positive, receive a molecular WHO-recommended rapid diagnostic test (eg, Xpert MTB/RIF [Xpert] assay). To inform updated WHO tuberculosis screening guidelines, we conducted a systematic review and individual participant data meta-analysis to assess the performance of W4SS and alternative screening tests to guide Xpert testing and compare the diagnostic accuracy of the WHO Xpert algorithm (ie, W4SS followed by Xpert) with Xpert for all HIV-positive inpatients. METHODS: We searched MEDLINE, Embase, and Cochrane Library from Jan 1, 2011, to March 1, 2020, for studies of adult and adolescent HIV-positive inpatients enrolled regardless of tuberculosis signs and symptoms. The separate reference standards were culture and Xpert. Xpert was selected since it is most likely to be the confirmatory test used in practice. We assessed the proportion of inpatients eligible for Xpert testing using the WHO algorithm; assessed the accuracy of W4SS and alternative screening tests or strategies to guide diagnostic testing; and compared the accuracy of the WHO Xpert algorithm (W4SS followed by Xpert) with Xpert for all. We obtained pooled proportion estimates with a random-effects model, assessed diagnostic accuracy by fitting random-effects bivariate models, and assessed diagnostic yield descriptively. This systematic review has ...