The effectiveness of community-wide screening for pulmonary tuberculosis: a systematic review
Summary: This systematic review evaluated the effectiveness of community-wide screening for pulmonary tuberculosis (TB) in high-burden areas by analysing randomised controlled trials (RCTs). The review focused on interventions offering TB screening to entire communities, comparing them to standard c...
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Elsevier
2025-01-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537024005893 |
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| author | Susanna S. van Wyk Ntombifuthi Blose Lester Kapanda-Phiri Mareli Claassens Taryn Young |
| author_facet | Susanna S. van Wyk Ntombifuthi Blose Lester Kapanda-Phiri Mareli Claassens Taryn Young |
| author_sort | Susanna S. van Wyk |
| collection | DOAJ |
| description | Summary: This systematic review evaluated the effectiveness of community-wide screening for pulmonary tuberculosis (TB) in high-burden areas by analysing randomised controlled trials (RCTs). The review focused on interventions offering TB screening to entire communities, comparing them to standard care or alternative approaches. The main outcome assessed was microbiologically confirmed TB diagnoses, including rates and prevalence. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, WHO Global Index Medicus, Web of Science, and trial registries up to 27 May 2024, without language restrictions. Screening, data extraction, and risk of bias assessment were done in duplicate. Results were not pooled. Certainty of the evidence was assessed using GRADE. PROSPERO: CRD42023453356. We included six cluster-RCTs after screening 2460 titles/abstracts and 86 full-text articles. The evidence for symptom screening was very uncertain. We found that sputum smear microscopy screening may result in little to no difference in the prevalence of culture-confirmed TB (n = 962,655, RR 1.09; 95% CI: 0.86–1.38, 1 RCT, low certainty evidence). Community-wide nucleic acid amplification test (NAAT) screening probably reduces the prevalence of NAAT-positive TB (n = 105,108, RR 0.56; 95% CI: 0.40–0.78, 1 RCT, moderate certainty evidence). Community-wide screening for pulmonary TB may reduce TB prevalence if done annually with an accurate screening test and high coverage. |
| format | Article |
| id | doaj-art-fe92c24b18cd46dd8f11ee913644bf33 |
| institution | Kabale University |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj-art-fe92c24b18cd46dd8f11ee913644bf332025-01-22T05:43:40ZengElsevierEClinicalMedicine2589-53702025-01-0179103010The effectiveness of community-wide screening for pulmonary tuberculosis: a systematic reviewSusanna S. van Wyk0Ntombifuthi Blose1Lester Kapanda-Phiri2Mareli Claassens3Taryn Young4Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Western Cape, South Africa; Corresponding author. Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, 7500, South Africa.Health Systems Trust, KwaZulu-Natal, South AfricaDivision of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Western Cape, South AfricaDepartment of Human, Biological and Translational Medical Science, University of Namibia, Windhoek, NamibiaDivision of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Western Cape, South AfricaSummary: This systematic review evaluated the effectiveness of community-wide screening for pulmonary tuberculosis (TB) in high-burden areas by analysing randomised controlled trials (RCTs). The review focused on interventions offering TB screening to entire communities, comparing them to standard care or alternative approaches. The main outcome assessed was microbiologically confirmed TB diagnoses, including rates and prevalence. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, WHO Global Index Medicus, Web of Science, and trial registries up to 27 May 2024, without language restrictions. Screening, data extraction, and risk of bias assessment were done in duplicate. Results were not pooled. Certainty of the evidence was assessed using GRADE. PROSPERO: CRD42023453356. We included six cluster-RCTs after screening 2460 titles/abstracts and 86 full-text articles. The evidence for symptom screening was very uncertain. We found that sputum smear microscopy screening may result in little to no difference in the prevalence of culture-confirmed TB (n = 962,655, RR 1.09; 95% CI: 0.86–1.38, 1 RCT, low certainty evidence). Community-wide nucleic acid amplification test (NAAT) screening probably reduces the prevalence of NAAT-positive TB (n = 105,108, RR 0.56; 95% CI: 0.40–0.78, 1 RCT, moderate certainty evidence). Community-wide screening for pulmonary TB may reduce TB prevalence if done annually with an accurate screening test and high coverage.http://www.sciencedirect.com/science/article/pii/S2589537024005893TuberculosisScreeningCommunity-wide interventionTuberculosis case finding |
| spellingShingle | Susanna S. van Wyk Ntombifuthi Blose Lester Kapanda-Phiri Mareli Claassens Taryn Young The effectiveness of community-wide screening for pulmonary tuberculosis: a systematic review EClinicalMedicine Tuberculosis Screening Community-wide intervention Tuberculosis case finding |
| title | The effectiveness of community-wide screening for pulmonary tuberculosis: a systematic review |
| title_full | The effectiveness of community-wide screening for pulmonary tuberculosis: a systematic review |
| title_fullStr | The effectiveness of community-wide screening for pulmonary tuberculosis: a systematic review |
| title_full_unstemmed | The effectiveness of community-wide screening for pulmonary tuberculosis: a systematic review |
| title_short | The effectiveness of community-wide screening for pulmonary tuberculosis: a systematic review |
| title_sort | effectiveness of community wide screening for pulmonary tuberculosis a systematic review |
| topic | Tuberculosis Screening Community-wide intervention Tuberculosis case finding |
| url | http://www.sciencedirect.com/science/article/pii/S2589537024005893 |
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