Does tuberculosis screening improve individual outcomes? A systematic review

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). Pubmed, EMBASE, Scopus...

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Published in:	EClinicalMedicine Vol. 40; p. 101127
Main 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, Ayles, H.M
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-10-2021 Elsevier
Subjects:	Active case-finding Case fatality Catastrophic costs Disease severity Economic consequences Enhanced case-finding Individual effects Mortality Patient costs Research paper Screening Treatment outcomes Individual effects Disease severity Screening Patient costs Catastrophic costs Case fatality Active case-finding Enhanced case-finding Mortality Treatment outcomes Economic consequences
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Summary:	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). 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. 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. We found very limited patient outcome data. Collecting and reporting this data must be prioritised to inform policy and practice. WHO and EDCTP.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2589-5370 2589-5370
DOI:	10.1016/j.eclinm.2021.101127