@article{e0f251fbf17b45388080283cc7f63ad2,
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 = "Funding Information: LT reports WHO consultancy work for the guideline development process and a Clinical Research Training Fellowship from the MRC (Grant Ref: MR/N020618/1). Funding Information: This work was commissioned by the WHO to update its TB screening guidelines and made possible through a grant from the WHO Global TB Programme. LT, MR, MAS, LM, TM, RK, RJH, VB, EK, HMA are funded by part of the EDCTP2 programme supported by the European Union (grant number RIA2016S-1632-TREATS). RMB, ELC and PM are funded by the Wellcome Trust (203905/Z/16/Z, 200901/Z/16/Z and 206575/Z/17/Z respectively). AES is supported by an NIH grant K23AI140918. The WHO, EDCTP, Wellcome Trust and NIH had no role in the conduct of the study or writing the review. Funding Information: RMB reports salary support from my Wellcome Trust Clinical PhD fellowship, awarded through her institution, grant number 203905/Z/16/Z; received payment from WHO to her institution for work on systematic review linked to this present review (but different to this review). Funding Information: This work was commissioned by the WHO to update its TB screening guidelines and made possible through a grant from the WHO Global TB Programme. LT, MR, MAS, LM, TM, RK, RJH, VB, EK, HMA are funded by part of the EDCTP2 programme supported by the European Union (grant number RIA2016S-1632-TREATS). RMB, ELC and PM are funded by the Wellcome Trust (203905/Z/16/Z, 200901/Z/16/Z and 206575/Z/17/Z respectively). AES is supported by an NIH grant K23AI140918. The WHO, EDCTP, Wellcome Trust and NIH had no role in the conduct of the study or writing the review. Funding Information: JEG received a contract provided to Johns Hopkins University to conduct systematic reviews for the WHO's TB screening guidelines; received an NIH grant to conduct TB case finding in India, a second to test for and treat latent TB infection in Brazil; received UNITAID grants to conduct implementation research around latent TB infection in several African countries; and sat on the Scientific Advisory Board for the Aurum Institute in November 2019. Funding Information: ELC has received a Wellcome Trust Senior Research Fellowship in Clinical Science: 200901/Z/16/Z to their institution. Publisher Copyright: {\textcopyright} 2021 The Author(s)",
year = "2021",
month = oct,
doi = "10.1016/j.eclinm.2021.101127",
language = "English (US)",
volume = "40",
journal = "EClinicalMedicine",
issn = "2589-5370",
publisher = "Lancet Publishing Group",
}