Does tuberculosis screening improve individual outcomes? A systematic review

L. Telisinghe; M. Ruperez; M. Amofa-Sekyi; L. Mwenge; T. Mainga; R. Kumar; M. Hassan; L. H. Chaisson; F. Naufal; A. E. Shapiro; J. E. Golub; C. Miller; E. L. Corbett; R. M. Burke; P. MacPherson; R. J. Hayes; V. Bond; C. Daneshvar; E. Klinkenberg; H. M. Ayles

doi:10.1016/j.eclinm.2021.101127

Does tuberculosis screening improve individual outcomes? A systematic review

L. Telisinghe^*, M. Ruperez, M. Amofa-Sekyi, L. Mwenge, T. Mainga, R. Kumar, M. Hassan, L. H. Chaisson, F. Naufal, A. E. Shapiro, J. E. Golub, C. Miller, E. L. Corbett, R. M. Burke, P. MacPherson, R. J. Hayes, V. Bond, C. Daneshvar, E. Klinkenberg, H. M. Ayles

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

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) and catastrophic cost prevalence (n=4; range screened 9-45% vs PCF 12-61%) was lower among those screened. Interpretation: We found very limited patient outcome data. Collecting and reporting this data must be prioritised to inform policy and practice. Funding: WHO and EDCTP.

Original language	English
Article number	101127
Journal	eClinicalMedicine
Volume	40
DOIs	https://doi.org/10.1016/j.eclinm.2021.101127
Publication status	Published - Oct 2021
Externally published	Yes

ASJC Scopus subject areas

General Medicine

Keywords

Active case-finding
Case fatality
Catastrophic costs
Disease severity
Economic consequences
Enhanced case-finding
Individual effects
Mortality
Patient costs
Screening
Treatment outcomes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.eclinm.2021.101127

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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. (2021). Does tuberculosis screening improve individual outcomes? A systematic review. eClinicalMedicine, 40, Article 101127. https://doi.org/10.1016/j.eclinm.2021.101127

@article{d304bde3bb4d4e13900e050d6a9dd631,

title = "Does tuberculosis screening improve individual outcomes? A systematic review",

abstract = "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) and catastrophic cost prevalence (n=4; range screened 9-45% vs PCF 12-61%) was lower among those screened. Interpretation: We found very limited patient outcome data. Collecting and reporting this data must be prioritised to inform policy and practice. Funding: WHO and EDCTP.",

keywords = "Active case-finding, Case fatality, Catastrophic costs, Disease severity, Economic consequences, Enhanced case-finding, Individual effects, Mortality, Patient costs, Screening, Treatment outcomes",

author = "L. Telisinghe and M. Ruperez and M. Amofa-Sekyi and L. Mwenge and T. Mainga and R. Kumar and M. Hassan and Chaisson, {L. H.} and F. Naufal and Shapiro, {A. E.} and Golub, {J. E.} and C. Miller and Corbett, {E. L.} and Burke, {R. M.} and P. MacPherson and Hayes, {R. J.} and V. Bond and C. Daneshvar and E. Klinkenberg and Ayles, {H. M.}",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s)",

year = "2021",

month = oct,

doi = "10.1016/j.eclinm.2021.101127",

language = "English",

volume = "40",

journal = "eClinicalMedicine",

issn = "2589-5370",

publisher = "Elsevier Ltd.",

}

Telisinghe, L, Ruperez, M, Amofa-Sekyi, M, Mwenge, L, Mainga, T, Kumar, R, Hassan, M, Chaisson, LH, Naufal, F, Shapiro, AE, Golub, JE, Miller, C, Corbett, EL, Burke, RM, MacPherson, P, Hayes, RJ, Bond, V, Daneshvar, C, Klinkenberg, E & Ayles, HM 2021, 'Does tuberculosis screening improve individual outcomes? A systematic review', eClinicalMedicine, vol. 40, 101127. https://doi.org/10.1016/j.eclinm.2021.101127

TY - JOUR

T1 - Does tuberculosis screening improve individual outcomes? A systematic review

AU - Telisinghe, L.

AU - Ruperez, M.

AU - Amofa-Sekyi, M.

AU - Mwenge, L.

AU - Mainga, T.

AU - Kumar, R.

AU - Hassan, M.

AU - Chaisson, L. H.

AU - Naufal, F.

AU - Shapiro, A. E.

AU - Golub, J. E.

AU - Miller, C.

AU - Corbett, E. L.

AU - Burke, R. M.

AU - MacPherson, P.

AU - Hayes, R. J.

AU - Bond, V.

AU - Daneshvar, C.

AU - Klinkenberg, E.

AU - Ayles, H. M.

PY - 2021/10

Y1 - 2021/10

N2 - 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) and catastrophic cost prevalence (n=4; range screened 9-45% vs PCF 12-61%) was lower among those screened. Interpretation: We found very limited patient outcome data. Collecting and reporting this data must be prioritised to inform policy and practice. Funding: WHO and EDCTP.

AB - 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) and catastrophic cost prevalence (n=4; range screened 9-45% vs PCF 12-61%) was lower among those screened. Interpretation: We found very limited patient outcome data. Collecting and reporting this data must be prioritised to inform policy and practice. Funding: WHO and EDCTP.

KW - Active case-finding

KW - Case fatality

KW - Catastrophic costs

KW - Disease severity

KW - Economic consequences

KW - Enhanced case-finding

KW - Individual effects

KW - Mortality

KW - Patient costs

KW - Screening

KW - Treatment outcomes

UR - http://www.scopus.com/inward/record.url?scp=85122780577&partnerID=8YFLogxK

U2 - 10.1016/j.eclinm.2021.101127

DO - 10.1016/j.eclinm.2021.101127

M3 - Article

AN - SCOPUS:85122780577

SN - 2589-5370

VL - 40

JO - eClinicalMedicine

JF - eClinicalMedicine

M1 - 101127

ER -

Does tuberculosis screening improve individual outcomes? A systematic review

Abstract

ASJC Scopus subject areas

Keywords

UN SDGs

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