A systematic review of the number needed to screen for active TB among people living with HIV

Abstract

BACKGROUND: Systematic screening for active TB is recommended for all people living with HIV (PLWH); however, case detection remains poor globally. We investigated the yield of active case finding (ACF) by calculating the number needed to screen (NNS) to detect a case of active TB among PLWH.METHODS: We identified studies reporting ACF for TB among PLWH published from November 2010 to February 2020. We calculated crude NNS for Xpert- or culture-confirmed TB and weighted mean NNS stratified by screening approach, population/risk group, and country TB burden.RESULTS: Of the 27,221 abstracts screened, we identified 58 studies eligible for inclusion, including 5 in low/moderate TB incidence settings and 53 in medium/high incidence settings. Populations screened for TB included inpatients, outpatients not receiving antiretroviral therapy (ART), outpatients receiving ART, those with CD4 < 200 cells/µL, children aged ≤15 years, pregnant PLWH, and PLWH in prisons. Screening tools included symptom-based screening, chest X-ray, C-reactive protein levels, and Xpert. The weighted mean NNS varied across groups but was consistently low, ranging from 4 among inpatients in moderate/high TB burden settings to 137 among pregnant PLWH in moderate/high TB burden settings.CONCLUSIONS: ACF is a high yield intervention among PLWH. Approaches to screening should be tailored to local epidemiological and health-system contexts, and sensitive screening tools such as Xpert should be implemented where feasible.

Improving case detection through TB contact risk stratification by Xpert MTB/RIF Ultra and spatial parameters. Evaluation of an innovative ACF strategy in Mozambique

“…These figures are consistently higher than those reported for the country as a whole (36%) and justified (at the time when the study was designed) the strategy of universal testing for HIV individuals regardless of symptoms. Surprisingly, the number of TB/HIV cases found was lower than expected for this specific population (overall NNS of 789.5) and far from that reported in similar studies (33). Likewise, the prevalence of HIV among screened contacts was also lower than previously seen, and specific analysis are being conducted to better understand the HIV burden in several populations of the district.…”

Results of community-based TB and HIV screening among transgender women and male sex workers in Pakistan

“…The number needed to screen was lower among MSW than for transgender women (57 and 90 respectively) and 68 overall, and consistent with other population groups at higher risk of developing TB [32,33] and indicates that large numbers of individuals with TB can be reached by screening transgender women and MSW in Pakistan if the communities can be engaged. While the NNS for PLWHIV was much lower at 10 overall, these individuals were only identified by conducting the outreach and most NNS studies in PLWHIV are facilitybased.…”

The effect of systematic screening of the general population on TB case notification rates

“…We updated this review using similar methods. Our search was nested within a systematic review conducted by Chaisson 2021 (7) , investigating the number needed to screen to detect a person with TB in any population. For the number needed to screen review, Pubmed, EMBASE, Scopus and the Cochrane Library were searched from 1/11/2010-13/4/2020.…”

“…Title, abstract and full-text screens were broad; original research studies reporting on screening for all TB were identified. These studies identified by the Chaisson 2021 review (7) , and studies identified in the Kranzer 2013 review (6) were assessed for eligibility for our review.…”