Tuberculosis screening among ambulatory people living with HIV:a systematic review and individual participant data meta-analysis

作者：Dhana, Ashar, Hamada, Yohhei, Kengne, Andre P., Kerkhoff, Andrew D., Rangaka, Molebogeng X., Kredo, Tamara, Baddeley, Annabel, Miller, Cecily, Singh, Satvinder, Hanifa, Yasmeen, Grant, Alison D., Fielding, Katherine, Affolabi, Dissou, Merle, Corinne S., Wachinou, Ablo Prudence, Yoon, Christina, Cattamanchi, Adithya, Hoffmann, Christopher J., Martinson, Neil, Mbu, Eyongetah Tabenyang, Sander, Melissa S., Balcha, Taye T., Skogmar, Sten, Reeve, Byron W.P., Theron, Grant, Ndlangalavu, Gcobisa, Modi, Surbhi, Cavanaugh, Joseph, Swindells, Susan, Chaisson, Richard E., Ahmad Khan, Faiz, Howard, Andrea A., Wood, Robin, Thit, Swe Swe, Kyi, Mar Mar, Hanson, Josh, Drain, Paul K., Shapiro, Adrienne E., Kufa, Tendesayi, Churchyard, Gavin, Nguyen, Duc T., Graviss, Edward A., Bjerrum, Stephanie, Johansen, Isik S., Gersh, Jill K., Horne, David J., LaCourse, Sylvia M., Al-Darraji, Haider Abdulrazzaq Abed, Kamarulzaman, Adeeba, Kempker, Russell R., Tukvadze, Nestani, Barr, David A., Meintjes, Graeme, Maartens, Gary, Ashar Dhana, Yohhei Hamada, André Pascal Kengne, Andrew D. Kerkhoff, Molebogeng X. Rangaka, Tamara Kredo, Annabel Baddeley, Cecily Miller, Satvinder Singh, Yasmeen Hanifa, Alison D. Grant, Katherine Fielding, Dissou Affolabi, Corinne Merle, Ablo Prudence Wachinou, Christina Yoon, Adithya Cattamanchi, Christopher J. Hoffmann, Neil Martinson, Eyongetah Tabenyang Mbu, Melissa Sander, Taye Tolera Balcha, Sten Skogmar, Byron W P Reeve, Grant Theron, Gcobisa Ndlangalavu, Surbhi Modi, Joseph S. Cavanaugh, Susan Swindells, Richard E. Chaisson, Andrea A. Howard, Robin Wood, Swe Swe Thit, Mar Mar Kyi, Josh Hanson, Paul K. Drain, Adrienne E. Shapiro, Tendesayi Kufa, Gavin Churchyard, Duc T. Nguyen, Edward A. Graviss, Stephanie Bjerrum, Işık Somuncu Johansen, Jill K. Gersh, David Horné, Sylvia M. LaCourse, Haider Abdulrazzaq Abed Al‐Darraji, Adeeba Kamarulzaman, Russell R. Kempker, Nestani Tukvadze, David Barr, Graeme Meintjes, Gary Maartens · 年份：2021 · 被引用次数：60 · 研究领域：Tuberculosis Research and Epidemiology、Pneumocystis jirovecii pneumonia detection and treatment、Infectious Diseases and Tuberculosis

BACKGROUND: The WHO-recommended tuberculosis screening and diagnostic algorithm in ambulatory people living with HIV is a four-symptom screen (known as the WHO-recommended four symptom screen [W4SS]) followed by a WHO-recommended molecular rapid diagnostic test (eg Xpert MTB/RIF [hereafter referred to as Xpert]) if W4SS is positive. To inform updated WHO guidelines, we aimed to assess the diagnostic accuracy of alternative screening tests and strategies for tuberculosis in this population. METHODS: In this systematic review and individual participant data meta-analysis, we updated a search of PubMed (MEDLINE), Embase, the Cochrane Library, and conference abstracts for publications from Jan 1, 2011, to March 12, 2018, done in a previous systematic review to include the period up to Aug 2, 2019. We screened the reference lists of identified pieces and contacted experts in the field. We included prospective cross-sectional, observational studies and randomised trials among adult and adolescent (age ≥10 years) ambulatory people living with HIV, irrespective of signs and symptoms of tuberculosis. We extracted study-level data using a standardised data extraction form, and we requested individual participant data from study authors. We aimed to compare the W4SS with alternative screening tests and strategies and the WHO-recommended algorithm (ie, W4SS followed by Xpert) with Xpert for all in terms of diagnostic accuracy (sensitivity and specificity), overall and in key subgroups (e...