Open AccessA systematic review of the number needed to screen for active TB among people living with HIV
Author(s) -
Lelia H. Chaisson,
Fahd Naufal,
Pamela Delgado-Barroso,
Hector S Alvarez-Manzo,
Katherine Robsky,
Cecily Miller,
Jonathan E. Golub,
Adrienne E. Shapiro
Publication year - 2021
Publication title -
the international journal of tuberculosis and lung disease/the international journal of tuberculosis and lung disease. articles traduits en français ...
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.103
H-Index - 110
eISSN - 1815-7920
pISSN - 1027-3719
DOI - 10.5588/ijtld.21.0049
Subject(s) - medicine , incidence (geometry) , human immunodeficiency virus (hiv) , antiretroviral therapy , epidemiology , case finding , tuberculosis , population , psychological intervention , pediatrics , family medicine , environmental health , viral load , pathology , psychiatry , physics , optics
BACKGROUND: Systematic screening for active TB is recommended for all people living with HIV (PLWH); however, case detection remains poor globally. We investigated the yield of active case finding (ACF) by calculating the number needed to screen (NNS) to detect a case of active TB among PLWH. METHODS: We identified studies reporting ACF for TB among PLWH published from November 2010 to February 2020. We calculated crude NNS for Xpert- or culture-confirmed TB and weighted mean NNS stratified by screening approach, population/risk group, and country TB burden. RESULTS: Of the 27,221 abstracts screened, we identified 58 studies eligible for inclusion, including 5 in low/moderate TB incidence settings and 53 in medium/high incidence settings. Populations screened for TB included inpatients, outpatients not receiving antiretroviral therapy (ART), outpatients receiving ART, those with CD4 < 200 cells/µL, children aged ≤15 years, pregnant PLWH, and PLWH in prisons. Screening tools included symptom-based screening, chest X-ray, C-reactive protein levels, and Xpert. The weighted mean NNS varied across groups but was consistently low, ranging from 4 among inpatients in moderate/high TB burden settings to 137 among pregnant PLWH in moderate/high TB burden settings. CONCLUSIONS: ACF is a high yield intervention among PLWH. Approaches to screening should be tailored to local epidemiological and health-system contexts, and sensitive screening tools such as Xpert should be implemented where feasible.