| Title: |
Tuberculosis screening among ambulatory people living with HIV: a systematic review and individual participant data meta-analysis |
| Authors: |
Dhana, A; Hamada, Y; Kengne, AP; Kerkhoff, AD; Rangaka, MX; Kredo, T; Baddeley, A; Miller, C; Singh, S; Hanifa, Y; Grant, AD; Fielding, K; Affolabi, D; Merle, CS; Wachinou, AP; Yoon, C; Cattamanchi, A; Hoffmann, CJ; Martinson, N; Mbu, ET; Sander, MS; Balcha, TT; Skogmar, S; Reeve, BWP; Theron, G; Ndlangalavu, G; Modi, S; Cavanaugh, J; Swindells, S; Chaisson, RE; Ahmad Khan, F; Howard, AA; Wood, R; Thit, SS; Kyi, MM; Hanson, J; Drain, PK; Shapiro, AE; Kufa, T; Churchyard, G; Nguyen, DT; Graviss, EA; Bjerrum, S; Johansen, IS; Gersh, JK; Horne, DJ; LaCourse, SM; Al-Darraji, HAA; Kamarulzaman, A; Kempker, RR; Tukvadze, N; Barr, DA; Meintjes, G; Maartens, G |
| Source: |
The Lancet Infectious Diseases (2021) (In press). |
| Publication Year: |
2021 |
| Collection: |
University College London: UCL Discovery |
| Description: |
BACKGROUND: The WHO-recommended tuberculosis screening and diagnostic algorithm in ambulatory people living with HIV is a four-symptom screen (known as the WHO-recommended four symptom screen [W4SS]) followed by a WHO-recommended molecular rapid diagnostic test (eg Xpert MTB/RIF [hereafter referred to as Xpert]) if W4SS is positive. To inform updated WHO guidelines, we aimed to assess the diagnostic accuracy of alternative screening tests and strategies for tuberculosis in this population. METHODS: In this systematic review and individual participant data meta-analysis, we updated a search of PubMed (MEDLINE), Embase, the Cochrane Library, and conference abstracts for publications from Jan 1, 2011, to March 12, 2018, done in a previous systematic review to include the period up to Aug 2, 2019. We screened the reference lists of identified pieces and contacted experts in the field. We included prospective cross-sectional, observational studies and randomised trials among adult and adolescent (age ≥10 years) ambulatory people living with HIV, irrespective of signs and symptoms of tuberculosis. We extracted study-level data using a standardised data extraction form, and we requested individual participant data from study authors. We aimed to compare the W4SS with alternative screening tests and strategies and the WHO-recommended algorithm (ie, W4SS followed by Xpert) with Xpert for all in terms of diagnostic accuracy (sensitivity and specificity), overall and in key subgroups (eg, by antiretroviral therapy [ART] status). The reference standard was culture. This study is registered with PROSPERO, CRD42020155895. FINDINGS: We identified 25 studies, and obtained data from 22 studies (including 15 666 participants; 4347 [27·7%] of 15 663 participants with data were on ART). W4SS sensitivity was 82% (95% CI 72-89) and specificity was 42% (29-57). C-reactive protein (≥10 mg/L) had similar sensitivity to (77% [61-88]), but higher specificity (74% [61-83]; n=3571) than, W4SS. Cough (lasting ≥2 weeks), haemoglobin ( |
| Document Type: |
article in journal/newspaper |
| File Description: |
text |
| Language: |
English |
| Relation: |
https://discovery.ucl.ac.uk/id/eprint/10139504/ |
| Availability: |
https://discovery.ucl.ac.uk/id/eprint/10139504/1/1-s2.0-S147330992100387X-main.pdf; https://discovery.ucl.ac.uk/id/eprint/10139504/ |
| Rights: |
open |
| Accession Number: |
edsbas.AE8F57A6 |
| Database: |
BASE |