Number needed to screen for TB in clinical, structural or occupational risk groups
METHODS: We conducted a literature search for studies reporting ACF for adults published between November 2010 and February 2020. We determined active TB prevalence detected through various screening strategies and calculated crude NNS for - TB confirmed using culture or Xpert® MTB/RIF, and weighted mean NNS stratified by screening strategy, risk group, and country-level TB incidence.
RESULTS: We screened 27,223 abstracts; 90 studies were included (41 in low/moderate and 49 in medium/high TB incidence settings). High-risk groups included inpatients, outpatients, people living with diabetes (PLWD), migrants, prison inmates, persons experiencing homelessness (PEH), healthcare workers, and miners. Screening strategies included symptom-based screening, chest X-ray and Xpert testing. NNS varied widely across and within incidence settings based on risk groups and screening methods. Screening tools with higher sensitivity (e.g., Xpert, CXR) were associated with lower NNS estimates.
CONCLUSIONS: NNS for ACF strategies varies substantially between adult risk groups. Specific interventions should be tailored based on local epidemiology and costs.
Keywords: active case finding; number needed to screen; risk groups; screening; tuberculosis
Document Type: Research Article
Affiliations: 1: Department of Medicine, Johns Hopkins University, Baltimore, MD 2: Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL 3: Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA 4: Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA 5: World Health Organization, Geneva, Switzerland 6: Departments of Global Health and Medicine, University of Washington, Seattle, WA 7: Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA, Department of International Health, Johns Hopkins University, Baltimore, MD, USA
Publication date: June 1, 2022
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