1. Tuberculosis screening among ambulatory people living with HIV: a systematic review and individual participant data meta-analysis
- Author
-
Dhana, Ashar, Hamada, Yohhei, Kengne, Andre P, Kerkhoff, Andrew D, Rangaka, Molebogeng X, Kredo, Tamara, Baddeley, Annabel, Miller, Cecily, Singh, Satvinder, Hanifa, Yasmeen, Grant, Alison D, Fielding, Katherine, Affolabi, Dissou, Merle, Corinne S, Wachinou, Ablo Prudence, Yoon, Christina, Cattamanchi, Adithya, Hoffmann, Christopher J, Martinson, Neil, Mbu, Eyongetah Tabenyang, Sander, Melissa S, Balcha, Taye T, Skogmar, Sten, Reeve, Byron WP, Theron, Grant, Ndlangalavu, Gcobisa, Modi, Surbhi, Cavanaugh, Joseph, Swindells, Susan, Chaisson, Richard E, Khan, Faiz Ahmad, Howard, Andrea A, Wood, Robin, Thit, Swe Swe, Kyi, Mar Mar, Hanson, Josh, Drain, Paul K, Shapiro, Adrienne E, Kufa, Tendesayi, Churchyard, Gavin, Nguyen, Duc T, Graviss, Edward A, Bjerrum, Stephanie, Johansen, Isik S, Gersh, Jill K, Horne, David J, LaCourse, Sylvia M, Al-Darraji, Haider Abdulrazzaq Abed, Kamarulzaman, Adeeba, Kempker, Russell R, Tukvadze, Nestani, Barr, David A, Meintjes, Graeme, and Maartens, Gary
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Health Sciences ,Tuberculosis ,HIV/AIDS ,Infectious Diseases ,Sexually Transmitted Infections ,Rare Diseases ,Emerging Infectious Diseases ,4.2 Evaluation of markers and technologies ,Infection ,Good Health and Well Being ,Adolescent ,Adult ,Antibiotics ,Antitubercular ,Child ,Cross-Sectional Studies ,HIV Infections ,Humans ,Mycobacterium tuberculosis ,Prospective Studies ,Rifampin ,Sensitivity and Specificity ,Tuberculosis ,Pulmonary ,Medical Microbiology ,Public Health and Health Services ,Microbiology ,Clinical sciences ,Medical microbiology ,Epidemiology - Abstract
BackgroundThe 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.MethodsIn 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.FindingsWe 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 (
- Published
- 2022