The benefits to communities and individuals of screening for active tuberculosis disease: a systematic review [State of the art series. Case finding/screening. Number 2 in the series]

Kranzer, Katharina; Afnan-Holmes, Hoviyeh; Tomlin, Keith; Golub, J. E.; Shapiro, Adrienne E.; Schaap, Albertus; Corbett, Elizabeth L.; Lönnroth, Knut; Glynn, Judith R.

doi:10.5588/ijtld.12.0743

Cited by 205 publications

(234 citation statements)

References 31 publications

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“…88 Before the mid-1970s, radiological screening was widely implemented, but without clear demonstration of its impact on TB epidemiology or individual benefit. 44,88 Mobile radiography is still used in some European towns to screen high-risk groups such as the homeless and drug users, with acceptable NNTS and costeffectiveness. 65,69 The South African mining industry has used annual screening since the 1930s.…”

Section: Tuberculosis Screening Using Different Tuberculosis Entry Pomentioning

confidence: 99%

“…However, undiagnosed TB in these subgroups is more of a symptom than the main contributor to TB transmission in communities. 35,44 …”

mentioning

confidence: 99%

“…Understanding the impact of screening on 'patient-important outcomes' such as survival and well-being, and population-level epidemiological impact are critical in guiding choices and investment. 44,46,104 Mathematical modelling can identify and clarify important key principles, identify misconceptions, constraints and theoretical limitations, as well as being a tool to guide realistic study design, cost-effectiveness and provide fuller analysis and projection of real-life data. 36,84,99,100,105 Among our most pressing needs are new diagnostics: a highly sensitive, portable, low-cost, point-of-care diagnostic able to 'rule out' TB effectively would revolutionise TB screening at all levels of the health system and community and allow rapid scale-up of HIV testing.…”

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confidence: 99%

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Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

Corbett

MacPherson²

2013

int j tuberc lung dis

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SUMMARYTwenty years of sky-high tuberculosis (TB) incidence rates and high TB mortality in high human immunodeficiency virus (HIV) prevalence countries have so far not been matched by the same magnitude or breadth of responses as seen in malaria or HIV programmes. Instead, recommendations have been narrowly focused on people presenting to health facilities for investigation of TB symptoms, or for HIV testing and care. However, despite the recent major investment and scale-up of TB and HIV services, undiagnosed TB remains highly prevalent at community level, implying that diagnosis of TB remains slow and incomplete. This maintains high transmission rates and exposes people living with HIV to high rates of morbidity and mortality.More intensive use of TB screening, with broader definitions of target populations, expanded indications for screening both inside and outside of health facilities, and appropriate selection of new diagnostic tools, offers the prospect of rapidly improving population-level control of TB. Diagnostic accuracy of suitable (high throughput) algorithms remains the major barrier to realising this goal.In the present study, we review the evidence available to guide expanded TB screening in HIVprevalent settings, ideally through combined TB-HIV interventions that provide screening for both TB and HIV, and maximise entry to HIV and TB care and prevention. Ideally, we would systematically test, treat and prevent TB and HIV comprehensively, offering both TB and HIV screening to all health facility attendees, TB households and all adults in the highest risk communities. However, we are still held back by inadequate diagnostics, financing and paucity of population-impact data. Relevant contemporary research showing the high need for potential gains, and pitfalls from expanded and intensified TB screening in high HIV prevalence settings are discussed in this review. In high human immunodeficiency virus (HIV) prevalence settings, population-level tuberculosis (TB) incidence increased in parallel with adult HIV prevalence in the 1990s and remains extremely high, with over 1% of adults diagnosed with TB each year in many Southern African towns. 1 Outbreaks of multi-and extensively drug-resistant TB (XDR-TB) have been generated in HIV care clinics, and then spread into general communities. 2,3 Autopsy studies show that TB is the single biggest killer of people living with HIV (PLHIV), being the cause in 32% to 45% of HIV-related deaths 4 and with a high proportion of fatal cases undiagnosed in life. 4,5 Of the estimated 430 000 TB-related deaths among PLHIV during 2011, 79% were in Africa. These stark facts demonstrate the urgent need to strengthen TB prevention and care services using all available approaches, including more ambitious TB screening strategies.TB screening is the first step in both anti-tuberculosis treatment and TB prevention pathways, and has an integral place in routine HIV care and infection control. Key potential entry points for TB screening are illustrated in Figure 1. TB screening c...

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Section: Tuberculosis Screening Using Different Tuberculosis Entry Pomentioning

confidence: 99%

“…However, undiagnosed TB in these subgroups is more of a symptom than the main contributor to TB transmission in communities. 35,44 …”

mentioning

confidence: 99%

mentioning

confidence: 99%

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Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

Corbett

MacPherson²

2013

int j tuberc lung dis

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“…Additionally, a recent review of the active case-finding literature concurred that the individual and communitylevel benefits from active screening for TB disease remain uncertain. [8] However, mathematical modelling has shown that transmission during subclinical TB disease may be an important impediment to current TB control measures, a finding that supports a re-evaluation of active screening. [9] RESEARCH Cape Town's MMR screening programme was in existence from 1948 to 1994.…”

Section: Researchmentioning

confidence: 99%

“…The evidence base for active case finding as such a strategy in similar high-burden settings is limited, [8] although there have been some promising results regarding the impact on earlier case detection and population TB incidence. [13,14] This study adds to these limited data on effectiveness, and even more sparse data on mass radiography.…”

Section: Researchmentioning

confidence: 99%

The mass miniature chest radiography programme in Cape Town, South Africa, 1948 - 1994: The impact of active tuberculosis case finding

et al. 2016

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Symptom- and chest-radiography screening for active pulmonary tuberculosis in HIV-negative adults and adults with unknown HIV status

Hoog

Langendam

Mitchell

et al. 2014

Cochrane Database of Systematic Reviews

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The benefits to communities and individuals of screening for active tuberculosis disease: a systematic review [State of the art series. Case finding/screening. Number 2 in the series]

Cited by 205 publications

References 31 publications

Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

The mass miniature chest radiography programme in Cape Town, South Africa, 1948 - 1994: The impact of active tuberculosis case finding

Symptom- and chest-radiography screening for active pulmonary tuberculosis in HIV-negative adults and adults with unknown HIV status

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