systematic review of number needed to screen (nns) in ... · jonathan e. golub center for...

Jonathan E. Golub

Center for Tuberculosis Research

Johns Hopkins University

Systematic review of number needed to screen (NNS) in selected risk groups with

different screening approaches

Adrienne Shapiro and Jonathan Golub

Center for Tuberculosis Research


Knut Lonnroth, Mukund Uplekar, Jacob Creswell

WHO

Presentation Outline

• Define case detection

• Need for increased detection

• Systematic review

• Populations ripe for screening

• Examples of successful case detection strategies

• Future plans

TB Case Finding Strategies

• Passive Case Finding– Patient initiated – self presentation with symptoms

– Current DOTS model

• Enhanced Case Finding ~ Active Case Finding– Patient initiated, but following a provider/program-

initiated information campaign

– Where does this fit? (more discussion later)

• Active/Intensified Case Finding– Provider/Program-initiated

– An attempt to detect most cases of a disease in a specific time period, geographic location or risk group

Rationale for Active Case Finding

Diagnose patients earlier in disease

Initiate therapy earlier

Reduce morbidity and mortality

Reduce transmission

Reduce incidence/prevalence

Current WHO Case Detection Policy

• Passive case finding (DOTS)

• 3 I’s (HIV only) Intensified case finding

(Isoniazid preventive therapy)

(Infection Control)

• Intensive Case Finding for contacts

– Children <5 (rarely done)

Current WHOCase Detection Policy

(Current/Old) Assumptions

• Smear is best/only diagnostic available

• Smear negative patients are non-infectious

• Smear negative patients become smear positive

• Most patients seek care when symptomatic

• Health system strengthening will work

• ACF too resource intensive

New Reality

• Smear is NOT the best technology available

• Smear negative patients ARE infectious

• Smear negative patients DIE before becoming smear positive

• Patients often do NOT seek care

• Health system strengthening has NOT been adequate

• New & old evidence may suggest otherwise

Screening vs Diagnosis

Screening

• Should be simple– Can be complex

• High sensitivity

• Rule out TB while potentially detecting IPT eligibles

Diagnosis

• Can be complex– Should be simple

• High specificity

• Accurate/early diagnosis of active TB

Estimated case detection rates in 2008, by region

78 7870

6557

47

0

10

20

30

40

50

60

70

80

90

Am

eric

as

Euro

pe

Wes

tern

Pac

ific

South

Eas

t Asi

a

EM

R

Afric

a

EMR = Eastern Mediterranean Region

Cas

e d

ete

ctio

n r

ate

(%

)

WHO 2009

C Dye, K Lonnroth, E Jaramillo, B Williams, M Raviglione. 2009. Bulletin of the WHO.

“Conclusion: Although TB control programmes have averted millions of deaths, their effects on transmission and incidence rates are not yet widely detectable.”

Systematic review of impact of active tuberculosis case finding strategies on case detection of active TB

• Objectives

– To perform a global inventory and review of historical, recent and ongoing active case finding initiatives, including unpublished experiences

– To identify risk groups for targeting ACF programs

– To identify most effective ACF strategies

Search Strategy

• Published literature

– PubMed/Medline

– EMBASE

– Scopus

• Grey literature

• Find abstracts & titles (broad search: TB + active case-finding)

• Read abstracts & titles in duplicate, include initial criteria (sensitivity)

• Read papers of included abstracts, determine final inclusion (specificity)

• Abstract data from included papers

• Summarize data

• Report

Abstract & Titles:Inclusion Criteria

• Abstract/keywords indicate tuberculosis and active case-finding are documented in paper (or in subset of paper population)

Excluded:

• Study population chosen based on TB status

• Annual risk of tuberculosis infection (ARTI) studies that did not indicate active screening beyond TST

• Reviews, commentaries, non-original contributions

• TNF-α inhibitor/rheumatology studies

Search termsDatabase Terms

PubMed/Medline

((("Mass Screening"[MeSH Terms] OR "Mass Chest X-Ray"[MeSH Terms] OR "contact tracing"[MeSH Terms] OR "health surveys"[MeSH Terms] OR "Cross-Sectional Studies"[MeSH Terms] OR "Epidemiologic Studies"[MeSH Terms]) OR ("Mass Chest X Ray" OR "Mass Chest X-Rays" OR "Mass Screenings" OR "Mass screening" OR "Screenings" OR "screening" OR "health survey" OR "Cross-Sectional Studies" OR "Case-detection" OR "case finding" OR "active case finding" OR "contact tracing" OR "intensified case-finding" OR "intensified case finding" OR "contact screening" OR "survey" OR "cross-sectional studies" OR "tuberculosis case-finding" OR "population screening" OR "prevalence studies")) AND (("tuberculosis"[MeSH Terms] OR "tuberculosis" OR "Pulmonary Consumption" OR "Consumption, Pulmonary" OR "Pulmonary Phthisis" OR "Tuberculoses") OR ("Mycobacterium tuberculosis"[MeSH terms]))) NOT("animals"[MeSH Terms] NOT ("humans"[MeSH Terms] AND "animals"[MeSH Terms]))

EMBASE

'tuberculosis'/exp OR 'lung tuberculosis'/exp OR 'lung tuberculosis' OR 'tuberculosis' OR 'pulmonary consumption' OR 'consumption, pulmonary' OR 'pulmonary phthisis' OR 'tuberculoses' AND ('tuberculosis control'/exp OR 'case finding'/exp OR 'mass radiography'/exp OR 'mass screening'/exp OR 'contact examination'/exp OR 'screening'/exp OR 'mass radiography' OR 'mass screening' OR 'contactexamination' OR 'population screening' OR 'mass roentgenologic screening' OR 'mass chest x ray' OR 'mass chest x-rays' OR 'mass screenings' OR 'screenings' OR 'screening' OR 'health survey' OR 'cross-sectional studies' OR 'case-detection' OR 'case finding' OR 'active case finding' OR 'contact tracing' OR 'intensified case-finding' OR 'intensified case finding' OR 'contact screening' OR 'cross-sectional' OR 'tuberculosis case-finding' OR 'prevalence studies') NOT ('animal'/exp NOT ('animal'/exp AND 'human'/exp))

SCOPUS

((KEY(tuberculosis OR phthisis OR (pulmonary consumption))) OR (TITLE(tuberculosis OR phthisis OR (pulmonary consumption)))) AND (TITLE-ABS-KEY((("Mass Chest X Ray") OR ("Mass Chest X-Rays") OR ("Mass Screenings") OR ("Mass screening") OR (screenings) OR (screening) OR ("health survey") OR ("Cross-Sectional Studies") OR ("Case-detection") OR ("case finding") OR ("active case finding") OR ("contact tracing") OR ("intensified case-finding") OR ("intensified case finding") OR ("contact screening") OR ("prevalence survey") OR ("cross-sectional studies") OR ("population screening") OR ("prevalence study"))))

Paper exclusion criteria

• Language other than: English, Japanese, Swedish, French, Spanish, Russian, (Portuguese, Dutch)

• Not an original contribution (e.g. paper is a review/commentary/author reply)

• No active case-finding documented in paper (regardless of intent of authors)

• No number/prevalence/incidence of active TB reported – TB disease must be detected actively; if paper does

not distinguish between passive and active case detection in reporting, will be excluded.

Grey Literature Summary• The following sources have been identified for review:

– FIDELIS Project reports (31 to screen)

– Conference abstracts from:

• American Thoracic Society conferences

• Union World Lung Conferences (IUATLD)

• IAS/AIDS

“Mop-up” Screening• Reference lists from recently published systematic reviews

• Consultation with experts in the field

Search Yield

Papers to include

(English only)*

Abstracts accepted/Papers to scan

Time period

Abstracts

(read in duplicate)N=30,757

2005-2010

N=9,750

N=572

N=192

Abs=73

1994-2004

N=10,899

N=467

N=146

Abs=3

Pre-1994

N=10,108

N=772

N=241

Abs=2

*Non-English papers still under review, anticipated inclusion of 26 Russian, 26 Japanese, 20 Spanish and ?French.

Population Screened/Study Type No. Papers % of all Included

General Inpatient 4 0.61

General Outpatient 18 2.7

VCT 5 0.8

Vaccine Trial 3 0.5

Community/Pop’n wide (e.g. door-to-door) 175 26.6

Enhanced CF 8 1.2

Immigration/Refugee/Border screen 24 3.7

Risk Group screen 144 21.9

HIV clinic/cohort 57 8.7

All other risk groups 86 13.1

Occupational screening (Military, Mines, Health Care) 48 7.3

Contact-tracing (e.g HH, School-based, Health Care) 145 22.1

Institutional settings (Prisons, Nursing Home, etc.) 62 9.4

Other 10 1.5

Included Papers & Abstracts (N=656)

Risk group subsets

Risk Groups No. Papers % Included

HIV clinic/cohort 57 8.7

Pregnant women & gynecologic clinics 15 2.3

Diabetes 10 1.5

Drug & Alcohol users 8 1.2

Homeless 17 2.6

Immigrants 22 3.4

Other disease risks 3 0.5

Other/multiple risk group 11 1.7

Paper characteristics

• 91 countries represented

• Incidence strata for analysis based on 2009 WHO TB incidence data:

– Low incidence: <30/100,000 (N=335 papers)

– Moderate incidence: 30-99/100,000 (N=60)

– Medium incidence: 100-299/100,000 (N=147)

– High incidence: 300+ (N=115)

Primary Results

• Calculate Number Needed to Screen (NNS) to detect one case of TB

– Number of persons screened / Number of persons diagnosed with TB

• Overall mean NNS reported (weighted by size of study)

• Stratified by screening strategy

• Studies that found 0 cases are not included in NNS calculations

• Screening defined as method applied to ALL persons

– If symptoms followed by sputum collection, the screening method is symptom screen

Primary Results

• NNS Stratified by Population screened

• Further stratification by background TB incidence, since incidence associated with mean NNS across all populations screened:

• Abbreviations: sx-symptoms; sm-AFB smear; cx-culture; CXR-Chest X-ray; NS-not specified

TB Incidence Mean NNS

Low incidence 886

Moderate incidence 866

Medium incidence 647

High incidence 527

Pop’n Screened/StudyType

Weighted Mean NNS(Range) (# studies)

Low Incidence Moderate Incidence Medium Incidence High Incidence

General Inpatient (N=5) 4687 (450-6159) (N=3)

-(-)

(N=0)

3363(-)

(N=1)

12 (-)

(N=1)

General Outpatient (N=18) 798 (46-2187)

(N=8)

30,000(-)

(N=1)

252(58-322)

(N=6)

779(7-806) (N=3)

VCT (N=5)-- --

73 (21-120)

(N=3)

16 (8-18)(N=2)

Vaccine Trial (N=3)-- --

315 (7-343)(N=3)

--

Community/Pop’n wide (N=175)

1038 (4-30,865)

(N=72)*

160 (15-1989)

(N=15)

576(22-4286)

(N=51)

490 (7-1626)(N=31)

Enhanced CF (N=6) 1679(159-1770)

(N=2)*--

197(46-242)

(N=3)

1066 (803-1255)(N=2)

*Category includes at least one study that found 0 cases of TB, not included in NNS calculation

Pop’n Screened/Study type (# Papers)

Weighted Mean NNS (Range) (# studies)

Risk group screen Low Incidence Moderate Incidence Medium Incidence High Incidence

HIV clinic/cohort (N=58) 171 (10-391)

(N=5)

215(23-315)

(N=4)

37(1-120)(N=20)

58(3-124)(N=28)*

Pregnancy/Gyn Clinic(N=15)

914 (18-3847)

(N=5)*

-- 49 (6-143)(N=5)

36 (5-50)(N=4)

Diabetes (N=10) 57 (27-71)(N=3)

2222

(N=1)

29(24-37)(N=2)

45 (17-53)(N=3)

Drug users (N=7) 119 (76-150)

(N=4)

5 (N=1)*

20 (8-20)(N=2)

--

Occupational screening (all) (N=48)

528 (26-5550)(N=18)*

52(19-187)

(N=4)

414.2 (14-842)(N=10)

124 (21-233)

(N=8)

Contact-tracing (all) (N=145) 206(3-

1770)(N=67)*

42(6-355)(N=18)

86(7-567)(N=22)*

34 (3-210)(N=22)


Pop’n Screened (# Papers)

Weighted Mean NNS (Range) (# studies)


Prisons (N=38) 2341 (19-2945) (N=17)*

184 (19-191)

(N=9)

67(7-153) (N=6)

198 (18-222)

(N=6)

Homeless (N=17) 348(22-1778)

(N=17)-- -- --

Immig./Refugee/Border (N=24)

121 (6-1630)(N=17)*

242(N=1)

131 (59-157)

(N=4)

291 (N=1)


HIV clinic/cohort

Low Incidence

Pop’n Screened/StudyType



HIV clinic/cohort(N=57)

171 (11-391)

(N=5)

215(23-316)

(N=4)

38(2-120)(N=20)

58(3-125)(N=28)*

list pubyr authnm country shorturb shortage basen primscrlist secscrlist dxlist nns if ptype=="10-RG-HIV clinic/cohort" & inc09==1

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| Year Author Country Setting Age Study Size Primary Secondary Diagnosis NNS |

| Screen Screen |

|------------------------------------------------------------------------------------------------------------------|

37. | 2010 Jam Iran Urban Adults & Children 262 TST Other NS 11 |

108. | 2009 Brassard Canada Urban Adults only 2123 TST Other Clinical Other 125 |

383. | 1996 Hoffman USA Urban Adults & Children 31 TST CXR Cx 11 |

406. | 1994 Kvale USA Adults only 1171 Sm Cx Sm Cx 391 |

417. | 1993 Guelar Spain Urban Adults & Children 839 CXR TST CXR Sm Cx 37 |

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. list pubyr authnm country shorturb shortage basen primscrlist secscrlist dxlist nns if ptype=="10-RG-HIV clinic/cohort" & inc09==2

+------------------------------------------------------------------------------------------------------------------+

| Year Author Country Setting Age Study Primary Secondary Diagnosis NNS |

| Size Screen Screen |

|-------------------------------------------------------------------------------------------------------------------|

16. | 2010 Sun China Urban Adults only 340 sx CXR Sm Cx CXR Sm Cx 23 |

113. | 2009 Qian China Peri-urban Adults only 195 sx CXR TST Sm CXR Sm 28 |

118. | 2008 Wang China NS Adults & Children 2550 sx CXR Sm CXR Sm 45 |

123. | 2008 Saraceni Brazil Urban Unknown 5357 TST NS 316 |

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| Year Author Country Setting Age Study Size Primary Screen Secondary Screen Diagnosis NNS |

|-------------------------------------------------------------------------------------------------------------------------------------------------------------|

32. | 2010 Dembele Burkina Faso Urban Adults only 2383 sx Sm CXR Sm Other 35 |

48. | 2010 Subramanian India Urban Adults only 188 Sm Sm 3 |

59. | 2010 Reddy Peru NS Adults only 435 sx CXR TST Sm Cx Other CXR Sm Cx 17 |

67. | 2009 Monkongdee Thailand, Vietnam Urban Adults only 1060 sx CXR Sm Cx Other CXR Sm Cx Clinical Other 8 |

80. | 2009 Gebi Nigeria Rural NS 1385 CXR CXR Sm 7 |

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97. | 2009 Musa Nigeria Multiple NS 18043 Other NS 26 |

104. | 2009 Rajasekaran India Urban Adults only 5099 sx CXR Sm CXR Sm Clinical Other 20 |

130. | 2008 Mahajan India NS NS 230 sx CXR Sm Cx CXR Sm Cx Clinical Other 7 |

134. | 2008 Shah Vietnam Rural Adults & Children 597 CXR CXR Sm Clinical 34 |

161. | 2008 Khawchaoenpor Thailand Urban Adults only 350 CXR TST CXR Sm Cx Clinical 7 |

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163. | 2008 Mazitov Russia NS NS 360 sx TST CXR Sm Sm 120 |

167. | 2008 Jittimanee Thailand Multiple Unknown 23593 Other NS 9 |

179. | 2008 Ngowi Tanzania Rural Adults & Children 233 sx CXR Sm Cx CXR Sm Cx Clinical Other 12 |

209. | 2006 Joseph Haiti Urban Adults only 28261 sx CXR Sm CXR Sm Clinical 86 |

225. | 2006 Maniar India NS Adults only 8640 CXR TST Sm Cx Other CXR Sm Cx Clinical Other 2 |

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269. | 2004 Louie Vietnam Urban Adults only 100 sx CXR Sm Cx 3 |

318. | 2000 Swaminathan India Urban Adults only 175 sx CXR TST Sm Cx CXR Cx Clinical Other 11 |

352. | 1998 Halsey Haiti Multiple Adults only 10521 sx CXR TST NS 44 |

389. | 1996 Saenghirunvattana Thailand NS Unknown 46 sx CXR Sm Cx CXR Sm Cx Clinical Other 46 |

398. | 1995 Aisu Uganda Urban Adults only 1524 sx CXR Sm CXR Sm Clinical 19 |

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7. | 2010 Agizew Botswana Multiple Adults only 2732 CXR CXR Sm Cx Clinical Other 64 |

17. | 2010 Bassett South Africa Urban Adults only 825 sx CXR Sm Cx Cx 6 |

19. | 2010 Dawson South Africa Urban Adults only 235 sx CXR Sm Cx Cx 5 |

22. | 2010 Houlihan South Africa Rural Adults only 810 sx CXR Sm CXR Sm 5 |

24. | 2010 Turinawe Rwanda Multiple NS 62835 Other NS 73 |

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27. | 2010 Lawn South Africa Urban NS 241 sx CXR Sm Cx Other CXR Sm Cx Other 3 |

33. | 2010 Yienya Kenya Urban Children only 249 TST Other 14 |

60. | 2010 Cain Cambodia, Vietnam, Thailand Multiple Adults & Children 1768 sx CXR Sm Cx Other Cx 7 |

62. | 2010 Sanguli Kenya NS Children only 485 sx CXR TST Other Other 12 |

83. | 2009 Song Rwanda NS Children only 325 sx CXR TST CXR Sm Cx Clinical Other 8 |

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85. | 2009 Braitstein Kenya Multiple Children only 6535 sx CXR TST Sm Other CXR Sm Clinical Other 28 |

88. | 2009 Shah Ethiopia Urban Adults only 453 sx CXR Sm Cx CXR Sm Cx 15 |

95. | 2009 Gideon South Africa Urban Adults only 429 sx TST IGRA Cx Cx 27 |

105. | 2009 Chea Cambodia NS NS 212 sx CXR Sm Cx Other CXR Sm Cx Clinical Other 6 |

116. | 2009 Lawn South Africa Urban Adults only 235 sx CXR Sm Cx Other Cx 5 |

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119. | 2008 Vandebriel Rwanda Multiple Unknown 10362 sx NS 39 |

168. | 2008 Melaku Ethiopia NS NS 1015 Other NS 6 |

178. | 2008 Tiam Lesotho NS Adults only 336 sx CXR CXR Sm 5 |

192. | 2007 Cain Cambodia Rural Adults only 455 Other CXR Sm Other 5 |

222. | 2006 Lawn South Africa NS NS 923 sx CXR Sm Cx CXR Sm Cx Clinical 13 |

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224. | 2006 Day South Africa NS Adults only 920 sx CXR Sm Cx CXR Sm Cx Clinical Other 25 |

249. | 2005 Elenga Cote d'Ivoire Urban Children only 282 sx CXR TST Sm Cx Other CXR Sm Cx Clinical Other 21 |

250. | 2005 Seyler Cote d'Ivoire Urban Adults only 129 sx CXR Sm Cx Sm Cx Other . |

277. | 2004 Mohammed South Africa Urban Adults only 129 sx CXR TST Sm Cx CXR Sm Cx 12 |

303. | 2003 Churchyard South Africa NS Adults only 338 sx CXR Sm Cx CXR Sm Cx Other 13 |

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373. | 1997 Gilks Kenya Peri-urban Adults only 587 TST Sm Cx CXR Sm Cx 12 |

379. | 1997 Hawken Kenya Urban Adults & Children 684 sx CXR TST Sm Cx CXR Sm Cx Clinical Other 15 |

402. | 1995 Godfrey-Faussett Zambia Peri-urban Adults only 95 sx CXR Sm Cx CXR Sm Cx Clinical 19 |

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Moderate Incidence

Medium Incidence


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High Incidence


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Household Contact-Tracing

Low incidence



116 (4-337)(N=15)*

42(8-355)(N=13)

84 (7-568)(N=23)

35(3-210)(N=20)

. list pubyr authnm country shorturb shortage basen primscrlist secscrlist dxlist nns if ptype=="22-CT-Household" & inc09==1

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3. | 2010 Kouw Netherlands NS Unknown 193 TST Sm Cx Other NS 22 |

20. | 2010 Garcia-Garcia Spain NS NS 159 sx CXR TST IGRA NS 53 |

43. | 2010 Zunic France Peri-urban Adults & Children 3027 Other NS 337 |

46. | 2010 Goodburn United Kingdom Urban Adults & Children 16 sx TST IGRA CXR Sm Cx Clinical Other . |

74. | 2009 Kilicaslan Turkey Urban Adults only 3310 sx CXR Sm CXR Sm Cx Clinical Other 36 |

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135. | 2008 Bakir Turkey Urban Children only 908 sx CXR TST IGRA CXR Sm Cx Clinical Other 114 |

233. | 2006 Khaljizadeh Iran NS Adults & Children 224 CXR TST Sm Sm 14 |

337. | 1999 Soren USA Urban Adults & Children 659 sx TST NS . |

367. | 1997 Vidal Spain Urban Adults & Children 3071 sx CXR TST Sm Cx CXR Sm Cx Other 18 |

421. | 1993 Ormerod United Kingdom Peri-urban Adults & Children 7017 sx CXR TST CXR Sm Cx Other 141 |

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439. | 1989 Sherif Egypt Urban Adults & Children 281 TST CXR 71 |

454. | 1986 Sullam USA Urban Adults & Children 831 TST CXR Sm Cx Clinical 277 |

464. | 1984 Capewell United Kingdom Urban Adults & Children 4445 CXR TST Sm 57 |

483. | 1982 Uhari Finland NS Children only 83 sx CXR TST CXR Cx Clinical 83 |

496. | 1979 Wells Barbados NS Adults & Children 16 TST CXR Sm Cx 4 |

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530. | 1973 Sharpe USA Urban Adults & Children 95 CXR TST NS 24 |

562. | 1963 Geiger USA NS Adults & Children 699 CXR TST CXR Sm Cx Clinical 12 |

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11. | 2010 Cavalcante Brazil Urban NS 699 sx CXR TST Sm CXR Sm Cx Clinical 27 |

79. | 2009 Ottomani Morocco Multiple Adults & Children 787683 sx CXR TST Sm CXR Sm Clinical 40 |

99. | 2009 Maciei Brazil Multiple Children only 155 sx CXR TST CXR Sm Cx Clinical Other 31 |

103. | 2009 Nguyen Laos Rural Adults & Children 317 sx TST Sm CXR Sm Clinical Other 80 |

107. | 2009 Liemane Latvia NS Children only 60 Other NS 15 |

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158. | 2008 Lee Hong Kong Urban Adults & Children 4661 sx CXR TST CXR Sm Cx Clinical 151 |

160. | 2008 Lin China NS Adults & Children 1773 CXR TST CXR Sm 355 |

278. | 2004 Caldeira Brazil Urban Children only 184 sx CXR TST Sm CXR Sm Cx Clinical 8 |

282. | 2004 Lemos Brazil Urban Adults & Children 269 sx CXR TST Sm Cx CXR Sm Cx Clinical Other 39 |

309. | 2001 Carvalho Brazil Urban Adults & Children 360 sx CXR TST CXR Sm Cx Clinical 60 |

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311. | 2001 Teixeira Brazil Urban Adults & Children 408 sx TST CXR Sm Cx Sm Cx 24 |

314. | 2000 Espinal Dominican Republic Urban Adults & Children 803 sx TST CXR Sm CXR Sm Cx Clinical 18 |

485. | 1981 Chen Singapore NS Adults & Children 6450 sx CXR TST Sm Clinical 45 |

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15. | 2010 Madhavi India NS Children only 172 Other NS . |

18. | 2010 Mangi Pakistan Urban Adults & Children 17247 sx NS 48 |

25. | 2010 Sanchez-Lofranco Philippines Urban NS 771 sx CXR Sm Cx CXR Sm Cx 155 |

28. | 2010 Sia Philippines Urban Adults & Children 897 sx CXR TST Sm Cx CXR Sm Cx Clinical 7 |

31. | 2010 Amanullah Pakistan Urban Children only 117 CXR TST Other NS 30 |

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56. | 2010 Schumacher Peru Urban Unknown 12581 sx Sm Cx Other 112 |

57. | 2010 Delawer Afghanistan Multiple Adults only 2837 sx Sm Sm 568 |

93. | 2009 Chen Taiwan NS Adults & Children 78 CXR TST IGRA NS . |

102. | 2009 Duenas Philippines NS Adults & Children 112 Sm Sm 7 |

143. | 2008 Taran Russia Urban Adults & Children 23 Other NS 12 |

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152. | 2008 Jong Gambia NS Adults & Children 1808 sx CXR Sm Cx CXR Sm Cx Clinical Other 47 |

176. | 2008 Achakzai Pakistan Urban Adults & Children 1118 sx CXR TST Sm NS 39 |

191. | 2007 Jackson-Sillah Gambia NS Adults & Children 2381 sx TST CXR CXR Sm Cx Clinical Other 73 |

254. | 2005 Becerra Peru Urban Adults & Children 3347 sx Sm Cx Sm Cx 305 |

287. | 2003 Bayona Peru Urban Adults & Children 945 sx Sm Sm Cx Other 20 |

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289. | 2003 Suggaravetsiri Thailand NS Adults & Children 1200 sx CXR TST Sm CXR Sm Cx 27 |

293. | 2003 Guwatudde Uganda Peri-urban Adults & Children 1206 sx CXR TST Sm Cx CXR Sm Cx Clinical 29 |

321. | 2000 Eckhoff Haiti Rural Adults only 61 sx CXR Sm CXR Sm Clinical 7 |

325. | 2000 Wang Taiwan Urban Adults & Children 4595 CXR Sm Cx 17 |

327. | 2000 Wares Nepal Rural Adults & Children 2298 Sm Sm 165 |

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451. | 1987 Bokhari Pakistan NS Adults & Children 1000 CXR TST CXR Clinical 7 |

463. | 1984 Akenzua Nigeria Urban Children only 332 TST CXR Sm 42 |

528. | 1974 Yad Pakistan Urban Adults & Children 15406 TST CXR 7 |

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5. | 2010 Fojo Kenya NS Unknown 72 sx Sm 36 |

23. | 2010 Shapiro South Africa Peri-urban Adults & Children 2771 sx Sm Cx Sm Cx 16 |

42. | 2010 Bisuta Fueza DR Congo Urban Adults & Children 296 CXR Sm Cx Sm Cx 22 |

58. | 2010 Chemutai Kenya NS Unknown 102 Other NS 11 |

86. | 2009 Marais South Africa Urban Children only 261 sx CXR TST CXR Cx Clinical Other 8 |

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101. | 2009 Song Cambodia Multiple Adults & Children 2639 sx CXR TST Sm CXR Sm Clinical 14 |

124. | 2008 den Boon South Africa Urban Adults only 3483 sx CXR Sm CXR Sm Cx 129 |

137. | 2008 Kruk South Africa Urban Children only 252 sx CXR TST CXR Clinical 8 |

215. | 2006 Sinfield Malawi Urban Children only 195 sx TST CXR Sm CXR Sm Clinical Other 5 |

294. | 2003 Zachariah Malawi Rural Adults & Children 461 sx Sm Sm 58 |

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330. | 1999 Schaaf South Africa Urban Children only 128 sx CXR TST Sm Cx Other CXR Cx Clinical Other 9 |

371. | 1997 Beyers South Africa Peri-urban Adults & Children 664 sx CXR TST Cx Other CXR Sm Cx Clinical 13 |

394. | 1996 Topley Malawi Urban Children only 282 sx CXR TST CXR Clinical Other 3 |

423. | 1993 Klausner DR Congo Urban Adults & Children 1258 sx CXR TST Cx 24 |

447. | 1987 Tibbit South Africa NS NS 21507 CXR Sm NS 23 |

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452. | 1987 Gilpin South Africa Rural Adults only 132 Sm Sm 33 |

465. | 1984 Saunders South Africa Urban Adults & Children 3047 CXR TST NS 19 |

480. | 1982 Nsanzumuhire Kenya Rural Adults & Children 345 Sm Cx Sm Cx 50 |

Moderate Incidence

Medium Incidence


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High Incidence


+-------------------------------------------------------------------------------------------------------------------------------------------------+


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484. | 1981 Aluoch Kenya Rural Adults & Children 598 Sm Cx Sm Cx 86 |

503. | 1978 Aluoch Kenya Rural Adults & Children 628 Sm Cx Sm Cx 210 |

+--------------------------------------------------------------------------------------------------------------------------------------------------+

Community-wide Screening



1038 (4-30,865)

(N=72)*

160 (15-1989)

(N=15)

564(22–4286)

(N=50)

489 (7-1626)(N=31)

. list pubyr authnm country shortage basen primscrlist secscrlist dxlist nns if ptype=="5-Community/Pop'n Wide" & inc09==1

+------------------------------------------------------------------------------------------------------------------------------------------------+

| Year Author Country Age(s) Study Size Primary Screen Secondary Screen Diagnosis NNS |

|------------------------------------------------------------------------------------------------------------------------------------------------|

126. | 2008 Rumman Jordan Adults only 61730 sx Sm Sm 30865 |

213. | 2006 Alavi Iran Children only 3906 sx TST CXR Sm Other CXR Sm Clinical Other 1302 |

214. | 2006 Garcia-Sancho Mexico Children only 858 sx CXR Sm Cx Clinical Other . |

262. | 2005 Magkanas Greece Adults only 4338 CXR CXR CXR . |

312. | 2001 Sanchez-Perez Mexico Adults only 6140 sx Sm Cx Sm Cx 362 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

320. | 2000 Leung United Kingdom Adults & Children 199 CXR Sm 100 |

409. | 1994 Lodi TB Work Grp Italy Adults & Children 7087 CXR TST CXR Other 296 |

412. | 1994 Caldwell USA Adults & Children 1005 TST CXR Sm Cx 503 |

413. | 1994 Alperstein Australia Children only 2290 TST CXR Sm Cx Clinical 1145 |

422. | 1993 al-Kassimi Saudi Arabia Adults & Children 7721 TST Cx 7721 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

444. | 1989 Beller USA Adults only 3343 CXR CXR Sm Cx 558 |

455. | 1986 Perez-Stable USA Adults & Children 1871 CXR TST Sm NS 936 |

471. | 1984 Rowlands Saudi Arabia Children (<15yo) only 973 sx TST CXR . |

472. | 1984 Grantland USA Children only 435 TST CXR . |

497. | 1979 Depoorter Belgium Adults & Children 1021099 CXR CXR CXR 3334 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

498. | 1979 Thomson United Kingdom NS 7753 CXR CXR CXR 1108 |

517. | 1975 Leowski Poland Adults only 9945235 CXR CXR CXR 620 |

523. | 1974 Tempest USA Adults & Children 635 TST CXR Sm Cx Other 127 |

531. | 1972 Carstairs United Kingdom NS . CXR CXR NS 1667 |

532. | 1972 Akkaynak Turkey Adults & Children 9965 CXR TST CXR Cx 95 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

533. | 1972 Swallow USA Adults & Children 103371 CXR TST CXR 6892 |

534. | 1971 Barnett Canada Adults & Children 1416734 CXR TST CXR CXR Clinical 966 |

538. | 1970 Loofbourow USA Adults only 17388 CXR CXR 8694 |

539. | 1970 Tizes USA Adults & Children 30065 CXR CXR CXR 3759 |

541. | 1970 Miller United Kingdom Adults & Children 107258 CXR TST CXR 725 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

542. | 1969 Wakamatsu Japan Adults & Children 73399 CXR TST CXR Cx 48 |

548. | 1967 Wilson Nauru NS 3398 CXR TST Sm Cx CXR 62 |

549. | 1965 Cunningham Canada Adults & Children 45034 CXR TST CXR Other 7506 |

553. | 1965 Hann Samoa Adults only 56965 CXR Cx CXR CXR Sm Cx 40 |

554. | 1965 Omran USA Adults & Children 1007 CXR CXR CXR 29 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

560. | 1964 Moore Canada Adults & Children 315 CXR TST CXR 4 |

563. | 1962 Miall Jamaica Adults only 4352 TST CXR Sm Cx 218 |

564. | 1962 Cory Bahamas Children only 7260 CXR TST CXR CXR 155 |

574. | 1960 Erin United Kingdom Adults only 2001 CXR Cx CXR Cx 501 |

575. | 1959 Yamaguchi Japan Adults & Children 14857 CXR TST CXR Sm Cx 244 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

578. | 1958 Posner United Kingdom Adults only 4373 CXR CXR CXR 729 |

579. | 1958 McDowell United Kingdom Adults & Children 351314 CXR CXR CXR Sm 288 |

585. | 1957 Sifontes USA Children only 525 TST CXR 10 |

586. | 1957 Coffman USA Children only 826 TST CXR 826 |

588. | 1957 Cochran United Kingdom Adults & Children 8236 CXR CXR CXR Sm 824 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

590. | 1956 Cochrane United Kingdom Adults & Children 5385 CXR CXR CXR Sm Clinical 898 |

592. | 1956 Kallqvist Sweden Adults & Children 172458 CXR CXR Sm Other 4107 |

594. | 1955 Yamaguchi Japan Adults & Children 50668 CXR TST CXR CXR Sm 17 |

595. | 1955 Brauner USA Adults & Children 18414 CXR CXR CXR 2046 |

597. | 1955 Hereen USA Adults only 222441 CXR CXR CXR Clinical 7945 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

598. | 1955 Rubinstein Australia Adults & Children 192297 CXR CXR CXR Sm Cx 585 |

600. | 1955 Cochrane United Kingdom Adults & Children 18127 CXR CXR CXR . |

601. | 1955 Carstairs United Kingdom Adults & Children 792 CXR TST CXR CXR . |

610. | 1952 Exner USA Unknown 103810 CXR CXR CXR 215 |

613. | 1952 Payne USA Adults & Children 440339 CXR CXR CXR 68 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

616. | 1952 Cochrane United Kingdom Adults only 17097 CXR CXR CXR Sm Cx 123 |

619. | 1952 SDDPH USA Adults & Children 245061 CXR CXR CXR Other 383 |

621. | 1951 Papanicolaou Greece Adults & Children 186459 CXR CXR CXR Clinical 62 |

622. | 1951 Pinner Australia Adults & Children 508 CXR TST CXR CXR Sm Cx 170 |

623. | 1951 Oechsli USA Adults only 37934 CXR CXR CXR Sm 558 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

624. | 1951 King Australia Adults & Children 3209 CXR TST CXR CXR 1605 |

625. | 1951 Blyton United Kingdom Unknown 264455 CXR CXR CXR 406 |

626. | 1950 Thompson New Zealand Adults only 292 CXR CXR Cx . |

627. | 1950 Christie USA Adults only 454130 CXR CXR CXR 98 |

628. | 1950 Pinner Australia Adults & Children 12874 TST CXR Sm Cx 1288 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

630. | 1950 Novak USA Adults & Children 14998 CXR CXR CXR 2500 |

631. | 1950 Nelson Sweden Adults & Children 1424436 CXR CXR CXR 162 |

632. | 1950 Cauley USA Adults & Children 528941 CXR CXR 2142 |

635. | 1949 Papanicolaou Greece Adults & Children 98128 CXR CXR CXR 43 |

636. | 1949 Handy USA Adults & Children 81253 CXR CXR 261 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

638. | 1949 Burke USA Adults & Children 51940 CXR CXR CXR Sm Clinical 79 |

640. | 1948 Canuteson USA Adults only 24468 CXR TST CXR 720 |

641. | 1948 Davies USA Adults & Children 5965 CXR CXR CXR Sm Cx 995 |

642. | 1947 Ayling USA Children only 35000 TST CXR Clinical 946 |

643. | 1947 Spector USA Adults & Children 37329 CXR CXR 108 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

644. | 1947 Sigurdsson Iceland Adults & Children 11605 CXR TST CXR CXR Sm Cx Clinical 164 |

648. | 1946 Turnbull USA Adults & Children 4825 CXR CXR CXR 242 |

649. | 1946 Wayburn United Kingdom Adults only 77016 CXR CXR 282 |

650. | 1946 Davies USA Adults & Children 301 TST CXR 38 |

653. | 1939 Douglas USA Adults & Children 114831 TST CXR 182 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

654. | 1924 Baker Canada Children only 1136 sx CXR TST CXR Clinical 190 |

655. | 1922 Ferguson Canada Children only 1346 sx TST CXR Clinical 135 |

656. | 1921 Fine USA Children only 1650 CXR CXR 138 |

+------------------------------------------------------------------------------------------------------------------------------------------------+


+-------------------------------------------------------------------------------------------------------------------------------------------+


|-------------------------------------------------------------------------------------------------------------------------------------------|

38. | 2010 Miller Brazil Adults & Children 23865 sx CXR Sm 1989 |

193. | 2007 Sandoval Ecuador Adults & Children 653 sx Sm Sm 15 |

197. | 2007 Odermatt Laos Unknown 13541 sx Sm Sm Clinical 713 |

285. | 2004 China TB Control Collaboration China Adults & Children 365079 sx CXR TST CXR Sm Cx CXR Sm Cx Clinical 273 |

Low Incidence


+------------------------------------------------------------------------------------------------------------------------------------------------+


|------------------------------------------------------------------------------------------------------------------------------------------------|

126. | 2008 Rumman Jordan Adults only 61730 sx Sm Sm 30865 |

213. | 2006 Alavi Iran Children only 3906 sx TST CXR Sm Other CXR Sm Clinical Other 1302 |

214. | 2006 Garcia-Sancho Mexico Children only 858 sx CXR Sm Cx Clinical Other . |

262. | 2005 Magkanas Greece Adults only 4338 CXR CXR CXR . |

312. | 2001 Sanchez-Perez Mexico Adults only 6140 sx Sm Cx Sm Cx 362 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

320. | 2000 Leung United Kingdom Adults & Children 199 CXR Sm 100 |

409. | 1994 Lodi TB Work Grp Italy Adults & Children 7087 CXR TST CXR Other 296 |

412. | 1994 Caldwell USA Adults & Children 1005 TST CXR Sm Cx 503 |

413. | 1994 Alperstein Australia Children only 2290 TST CXR Sm Cx Clinical 1145 |

422. | 1993 al-Kassimi Saudi Arabia Adults & Children 7721 TST Cx 7721 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

444. | 1989 Beller USA Adults only 3343 CXR CXR Sm Cx 558 |

455. | 1986 Perez-Stable USA Adults & Children 1871 CXR TST Sm NS 936 |

471. | 1984 Rowlands Saudi Arabia Children (<15yo) only 973 sx TST CXR . |

472. | 1984 Grantland USA Children only 435 TST CXR . |

497. | 1979 Depoorter Belgium Adults & Children 1021099 CXR CXR CXR 3334 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

498. | 1979 Thomson United Kingdom NS 7753 CXR CXR CXR 1108 |

517. | 1975 Leowski Poland Adults only 9945235 CXR CXR CXR 620 |

523. | 1974 Tempest USA Adults & Children 635 TST CXR Sm Cx Other 127 |

531. | 1972 Carstairs United Kingdom NS . CXR CXR NS 1667 |

532. | 1972 Akkaynak Turkey Adults & Children 9965 CXR TST CXR Cx 95 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

533. | 1972 Swallow USA Adults & Children 103371 CXR TST CXR 6892 |

534. | 1971 Barnett Canada Adults & Children 1416734 CXR TST CXR CXR Clinical 966 |

538. | 1970 Loofbourow USA Adults only 17388 CXR CXR 8694 |

539. | 1970 Tizes USA Adults & Children 30065 CXR CXR CXR 3759 |

541. | 1970 Miller United Kingdom Adults & Children 107258 CXR TST CXR 725 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

542. | 1969 Wakamatsu Japan Adults & Children 73399 CXR TST CXR Cx 48 |

548. | 1967 Wilson Nauru NS 3398 CXR TST Sm Cx CXR 62 |

549. | 1965 Cunningham Canada Adults & Children 45034 CXR TST CXR Other 7506 |

553. | 1965 Hann Samoa Adults only 56965 CXR Cx CXR CXR Sm Cx 40 |

554. | 1965 Omran USA Adults & Children 1007 CXR CXR CXR 29 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

560. | 1964 Moore Canada Adults & Children 315 CXR TST CXR 4 |

563. | 1962 Miall Jamaica Adults only 4352 TST CXR Sm Cx 218 |

564. | 1962 Cory Bahamas Children only 7260 CXR TST CXR CXR 155 |

574. | 1960 Erin United Kingdom Adults only 2001 CXR Cx CXR Cx 501 |

575. | 1959 Yamaguchi Japan Adults & Children 14857 CXR TST CXR Sm Cx 244 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

578. | 1958 Posner United Kingdom Adults only 4373 CXR CXR CXR 729 |

579. | 1958 McDowell United Kingdom Adults & Children 351314 CXR CXR CXR Sm 288 |

585. | 1957 Sifontes USA Children only 525 TST CXR 10 |

586. | 1957 Coffman USA Children only 826 TST CXR 826 |

588. | 1957 Cochran United Kingdom Adults & Children 8236 CXR CXR CXR Sm 824 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

590. | 1956 Cochrane United Kingdom Adults & Children 5385 CXR CXR CXR Sm Clinical 898 |

592. | 1956 Kallqvist Sweden Adults & Children 172458 CXR CXR Sm Other 4107 |

594. | 1955 Yamaguchi Japan Adults & Children 50668 CXR TST CXR CXR Sm 17 |

595. | 1955 Brauner USA Adults & Children 18414 CXR CXR CXR 2046 |

597. | 1955 Hereen USA Adults only 222441 CXR CXR CXR Clinical 7945 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

598. | 1955 Rubinstein Australia Adults & Children 192297 CXR CXR CXR Sm Cx 585 |

600. | 1955 Cochrane United Kingdom Adults & Children 18127 CXR CXR CXR . |

601. | 1955 Carstairs United Kingdom Adults & Children 792 CXR TST CXR CXR . |

610. | 1952 Exner USA Unknown 103810 CXR CXR CXR 215 |

613. | 1952 Payne USA Adults & Children 440339 CXR CXR CXR 68 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

616. | 1952 Cochrane United Kingdom Adults only 17097 CXR CXR CXR Sm Cx 123 |

619. | 1952 SDDPH USA Adults & Children 245061 CXR CXR CXR Other 383 |

621. | 1951 Papanicolaou Greece Adults & Children 186459 CXR CXR CXR Clinical 62 |

622. | 1951 Pinner Australia Adults & Children 508 CXR TST CXR CXR Sm Cx 170 |

623. | 1951 Oechsli USA Adults only 37934 CXR CXR CXR Sm 558 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

624. | 1951 King Australia Adults & Children 3209 CXR TST CXR CXR 1605 |

625. | 1951 Blyton United Kingdom Unknown 264455 CXR CXR CXR 406 |

626. | 1950 Thompson New Zealand Adults only 292 CXR CXR Cx . |

627. | 1950 Christie USA Adults only 454130 CXR CXR CXR 98 |

628. | 1950 Pinner Australia Adults & Children 12874 TST CXR Sm Cx 1288 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

630. | 1950 Novak USA Adults & Children 14998 CXR CXR CXR 2500 |

631. | 1950 Nelson Sweden Adults & Children 1424436 CXR CXR CXR 162 |

632. | 1950 Cauley USA Adults & Children 528941 CXR CXR 2142 |

635. | 1949 Papanicolaou Greece Adults & Children 98128 CXR CXR CXR 43 |

636. | 1949 Handy USA Adults & Children 81253 CXR CXR 261 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

638. | 1949 Burke USA Adults & Children 51940 CXR CXR CXR Sm Clinical 79 |

640. | 1948 Canuteson USA Adults only 24468 CXR TST CXR 720 |

641. | 1948 Davies USA Adults & Children 5965 CXR CXR CXR Sm Cx 995 |

642. | 1947 Ayling USA Children only 35000 TST CXR Clinical 946 |

643. | 1947 Spector USA Adults & Children 37329 CXR CXR 108 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

644. | 1947 Sigurdsson Iceland Adults & Children 11605 CXR TST CXR CXR Sm Cx Clinical 164 |

648. | 1946 Turnbull USA Adults & Children 4825 CXR CXR CXR 242 |

649. | 1946 Wayburn United Kingdom Adults only 77016 CXR CXR 282 |

650. | 1946 Davies USA Adults & Children 301 TST CXR 38 |

653. | 1939 Douglas USA Adults & Children 114831 TST CXR 182 |

|------------------------------------------------------------------------------------------------------------------------------------------------|

654. | 1924 Baker Canada Children only 1136 sx CXR TST CXR Clinical 190 |

655. | 1922 Ferguson Canada Children only 1346 sx TST CXR Clinical 135 |

656. | 1921 Fine USA Children only 1650 CXR CXR 138 |

+------------------------------------------------------------------------------------------------------------------------------------------------+


+-------------------------------------------------------------------------------------------------------------------------------------------+


|-------------------------------------------------------------------------------------------------------------------------------------------|

38. | 2010 Miller Brazil Adults & Children 23865 sx CXR Sm 1989 |

193. | 2007 Sandoval Ecuador Adults & Children 653 sx Sm Sm 15 |

197. | 2007 Odermatt Laos Unknown 13541 sx Sm Sm Clinical 713 |

285. | 2004 China TB Control Collaboration China Adults & Children 365079 sx CXR TST CXR Sm Cx CXR Sm Cx Clinical 273 |

419. | 1993 Hong South Korea Adults & Children 54870 CXR TST CXR Sm Cx 55 |

|-------------------------------------------------------------------------------------------------------------------------------------------|

428. | 1992 Zuluaga Colombia Adults only 3371 sx Sm Cx Sm Cx 338 |

486. | 1981 Ng Singapore Adults only 5413 CXR CXR Sm Clinical 53 |

510. | 1976 Sung South Korea Unknown 659000 sx Sm Sm Clinical 48 |

515. | 1975 Bolton Malaysia Adults & Children 71478 CXR CXR CXR Sm 148 |

518. | 1974 Marks Malaysia Unknown 2618 CXR CXR Sm 655 |

|-------------------------------------------------------------------------------------------------------------------------------------------|

520. | 1974 Roy Malaysia Adults only 19947 CXR CXR CXR Sm Clinical 93 |

521. | 1974 Yano Malaysia Adults & Children 633 CXR TST Sm CXR CXR Sm 53 |

571. | 1960 Harvey Singapore Adults only 54812 CXR CXR Sm Cx Clinical Other 35 |

603. | 1955 Chadwick China Adults & Children 40858 CXR CXR 48 |

646. | 1946 Eng China Adults & Children 5121 TST CXR 42 |

+-------------------------------------------------------------------------------------------------------------------------------------------+


+----------------------------------------------------------------------------------------------------------------------------------------+


|----------------------------------------------------------------------------------------------------------------------------------------|

2. | 2010 Rao India Adults only 11116 sx Sm Cx Sm Cx 67 |

9. | 2010 Bjerregaard-Andersen Guinea-Bissau Adults only 2989 sx CXR Sm 499 |

26. | 2010 Nabbuye Uganda Adults only 5103 sx Sm Sm 131 |


40. | 2010 Hoa Vietnam Adults only 94179 sx CXR Sm Cx Sm 351 |

|----------------------------------------------------------------------------------------------------------------------------------------|

50. | 2010 Shahed Hossain Bangladesh Adults only 63715 sx Sm Sm 2124 |

51. | 2010 Phuanukoonnon Papua New Guinea Unknown 7211 sx Sm Sm 601 |

100. | 2009 Sekandi Uganda Adults & Children 930 sx Sm Sm 29 |

110. | 2009 Tupasi Philippines Adults & Children 22867 sx CXR Sm Cx CXR Sm Cx 152 |

111. | 2009 Bhat India Adults only 22270 sx Other Sm Cx Sm Cx 269 |

|----------------------------------------------------------------------------------------------------------------------------------------|

131. | 2008 Gopi India Adults only 236010 sx CXR Sm Cx CXR Sm Cx Clinical 345 |

139. | 2008 Mapue Philippines Children only 15000 sx TST NS 25 |

199. | 2007 Akhtar Pakistan Adults only 5479 sx Sm Cx Sm Cx 305 |

200. | 2007 Soemantri Indonesia Adults only 50154 sx Sm Sm Cx Clinical 285 |

206. | 2006 Radhakrishna India Adults & Children 237276 CXR TST Cx CXR Cx 146 |

|----------------------------------------------------------------------------------------------------------------------------------------|

208. | 2006 Kasse Gambia Adults & Children 29871 sx CXR Sm CXR Sm Clinical 2298 |

217. | 2006 Fochsen India Adults only 45719 sx CXR Sm Cx Sm Cx 915 |


236. | 2006 Zaman Bangladesh Adults only 4235 sx Sm 82 |

265. | 2004 Murhekar India Adults only 10570 sx Sm 138 |

|----------------------------------------------------------------------------------------------------------------------------------------|

267. | 2004 Thorson Vietnam Adults only 35832 sx CXR Sm CXR Sm 1434 |

280. | 2004 Balasubramanian India Adults only 76011 sx CXR TST Sm Cx CXR Sm 330 |

292. | 2003 Guwatudde Uganda Adults & Children 1142 sx CXR Sm Cx Clinical 115 |

308. | 2001 TB research center India Adults & Children 100000 CXR CXR Sm Cx Clinical 115 |

313. | 2001 Datta India Adults & Children 26320 sx CXR TST CXR Sm Cx 209 |

|----------------------------------------------------------------------------------------------------------------------------------------|

336. | 1999 Tupasi Philippines Adults & Children 12850 sx CXR TST Sm Cx CXR Sm Cx Clinical 102 |

344. | 1999 Narang India Adults & Children 114266 sx Sm Cx Sm Cx 773 |

359. | 1998 Alvi Pakistan Adults & Children 1077 sx CXR Sm Clinical 40 |

385. | 1996 Schuurman Thailand Adults & Children 20730 sx Sm Cx 2304 |

400. | 1995 Balasubramanian India Adults only 5755 sx Sm Sm 480 |

|----------------------------------------------------------------------------------------------------------------------------------------|

403. | 1995 Chakraborty India Adults & Children 29400 TST Sm Cx Sm Cx 307 |

425. | 1992 Xavier India Adults only 11808 sx Sm Cx 288 |

427. | 1992 Narang India Adults & Children 773493 sx Sm Cx 618 |

432. | 1991 Hafez Bangladesh Adults & Children 3406 sx Sm 163 |

469. | 1984 Mayurnath India Adults & Children 18311 sx CXR TST CXR Cx 82 |

|----------------------------------------------------------------------------------------------------------------------------------------|

481. | 1982 Cassels Nepal Adults only 67068 sx Sm Sm 605 |

489. | 1981 Patel India Unknown 30000 sx Sm 4286 |

495. | 1979 Piot India Adults & Children 136167 sx CXR TST Sm CXR Sm 295 |

499. | 1979 Gothi India Adults & Children 24785 CXR TST CXR CXR Sm Cx 100 |

509. | 1976 Gothi India Adults & Children 22136 sx CXR TST Sm Cx 369 |

|----------------------------------------------------------------------------------------------------------------------------------------|

525. | 1974 Luan Taiwan Adults only 249189 sx CXR Sm CXR Sm Cx 887 |

526. | 1974 Vennema Tanzania Adults & Children 15102 CXR TST Sm Cx 720 |

527. | 1974 Rajagopal Indonesia Adults only 1990 CXR CXR CXR 69 |

535. | 1971 Vennema Vietnam NS 26362 TST CXR Sm 68 |

545. | 1968 Whatt Nigeria Adults & Children 2633 CXR TST CXR Sm 189 |

|----------------------------------------------------------------------------------------------------------------------------------------|

547. | 1968 Nagpaul India Adults & Children 33567 CXR TST Sm Cx CXR Sm Cx 50 |

558. | 1964 Roelsgaard Africa (multiple) Adults & Children 14846 CXR TST Sm CXR Sm 104 |

561. | 1963 Narain India Adults & Children 31967 CXR TST CXR CXR Sm Cx 82 |

565. | 1962 Hyslop Uganda Adults & Children 6413 TST CXR 802 |

570. | 1960 Islam Bangladesh Adults only 1645 TST CXR 30 |

|----------------------------------------------------------------------------------------------------------------------------------------|

612. | 1952 Davies Tanzania Adults & Children 5006 sx TST CXR Clinical 22 |

+----------------------------------------------------------------------------------------------------------------------------------------+

DIABETES

. list pubyr authnm country shorturb shortage basen primscrlist secscrlist dxlist nns if ptype=="12-RG-Dial/Kidney/Diab" & inc09==1

+---------------------------------------------------------------------------------------------------------------------+

| Year Author Country Setting Age(s) Study Primary Secondary Diagnosis NNS |


|---------------------------------------------------------------------------------------------------------------------|

331. | 1999 Al Shohaib Saudi Arabia Urban Adults only 80 CXR TST CXR Sm Cx . |

577. | 1958 Oscarsson Sweden NS Adults & Children 1270 CXR CXR 28 |

587. | 1957 Warwick United Kingdom Urban Adults & Children 1851 CXR CXR Sm 55 |

617. | 1952 Boucot USA Urban Adults & Children 3106 CXR CXR 71 |

+---------------------------------------------------------------------------------------------------------------------+


+---------------------------------------------------------------------------------------------------------+

Moderate Incidence


|-------------------------------------------------------------------------------------------------------------------------------------------|






|-------------------------------------------------------------------------------------------------------------------------------------------|






+-------------------------------------------------------------------------------------------------------------------------------------------+


+----------------------------------------------------------------------------------------------------------------------------------------+


|----------------------------------------------------------------------------------------------------------------------------------------|






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|----------------------------------------------------------------------------------------------------------------------------------------|






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|----------------------------------------------------------------------------------------------------------------------------------------|






|----------------------------------------------------------------------------------------------------------------------------------------|






|----------------------------------------------------------------------------------------------------------------------------------------|


+----------------------------------------------------------------------------------------------------------------------------------------+

DIABETES


+---------------------------------------------------------------------------------------------------------------------+



|---------------------------------------------------------------------------------------------------------------------|





+---------------------------------------------------------------------------------------------------------------------+


+---------------------------------------------------------------------------------------------------------+

Medium

Incidence

High Incidence


+---------------------------------------------------------------------------------------------------------------------------------------+


|---------------------------------------------------------------------------------------------------------------------------------------|

12. | 2010 Middelkoop South Africa Adults only 1250 sx Sm Cx Sm Cx 157 |

53. | 2010 Vandebriel Rwanda Unknown 52844 sx NS 826 |

63. | 2010 Amare Ethiopia Adults only 29257 sx Sm Cx Sm Cx 1626 |

64. | 2010 Corbett Zimbabwe Adults only 110432 sx Sm CXR Sm Cx Clinical 131 |

66. | 2010 Corbett Zimbabwe Adults only 8979 sx Sm Cx CXR Sm Cx Clinical Other 114 |

|---------------------------------------------------------------------------------------------------------------------------------------|

68. | 2009 Corbett Zimbabwe Adults only 10236 sx Sm Cx CXR Sm Cx Other Sm Cx Clinical Other 113 |

87. | 2009 Yimer Ethiopia Adults & Children 47478 sx Sm Sm 1250 |

112. | 2009 Ayles Zambia Adults only 8044 sx Sm Cx CXR Sm Cx 102 |

149. | 2008 Williams Cambodia Adults only 22160 sx CXR TST Sm CXR Sm Cx 39 |

186. | 2007 Corbett Zimbabwe Adults only 4668 sx Sm Cx CXR Sm Cx Clinical 173 |

|---------------------------------------------------------------------------------------------------------------------------------------|

188. | 2007 Wood South Africa Adults only 762 sx Sm Cx Sm Cx 34 |

194. | 2007 den Boon South Africa NS 3483 CXR Sm Cx CXR Sm Cx 152 |

210. | 2006 Shargie Ethiopia Adults only 16697 sx Sm 1285 |

219. | 2006 den Boon South Africa Adults only 2068 sx CXR Sm Cx Sm Cx 72 |

253. | 2005 Marais South Africa Children only 1415 sx CXR TST Sm Cx Other CXR Cx 79 |

|---------------------------------------------------------------------------------------------------------------------------------------|

479. | 1982 Aluoch Kenya Adults & Children 1006 sx Sm Cx 46 |

488. | 1981 Fourie South Africa Adults only 1386 sx CXR Sm Cx Sm Cx 29 |

490. | 1981 Nsanzumuhire Kenya Adults & Children 1074 sx Sm Cx 40 |

491. | 1980 Gatner South Africa Adults only 5477 CXR CXR Cx 7 |

492. | 1980 Fourie South Africa Adults only 2230 CXR Sm Cx Cx 24 |

|---------------------------------------------------------------------------------------------------------------------------------------|

500. | 1979 Arabin South Africa Adults only 1196 sx CXR Sm Cx CXR Sm Cx 48 |

507. | 1977 Nsanzumuhire Kenya Adults & Children 29508 sx Sm Cx 1135 |

522. | 1974 De Ville South Africa Adults only 1595 sx Sm Cx Cx 18 |

524. | 1974 Nyunt Myanmar Adults only 35206 sx CXR TST Sm Cx CXR Sm Cx 691 |

536. | 1971 Cox Zimbabwe Adults & Children 27981 CXR CXR CXR Sm 1217 |

|---------------------------------------------------------------------------------------------------------------------------------------|

552. | 1965 Spencer South Africa Children only 124977 TST CXR Other 68 |

557. | 1964 Scott South Africa Children only 35048 CXR TST CXR 423 |

569. | 1961 Roelsgaard Kenya Adults & Children 4944 CXR TST Sm CXR CXR Sm Cx 32 |

602. | 1955 Dubovsky South Africa Adults & Children 19886 CXR CXR CXR 175 |

604. | 1954 Schechter South Africa Adults & Children 21270 CXR TST CXR CXR 78 |

|---------------------------------------------------------------------------------------------------------------------------------------|

606. | 1954 Schneider South Africa Adults & Children 7569 CXR TST CXR CXR 127 |

+---------------------------------------------------------------------------------------------------------------------------------------+

Homeless PersonsWeighted Mean NNS

(Range) (# studies)


347.2(22-1777.5)

(N=17)-- -- --

. list pubyr authnm country shorturb shortage basen primscrlist secscrlist dxlist nns if ptype=="14-RG-Homeless" & inc09==1

+---------------------------------------------------------------------------------------------------------------------------------------------+

| Year Author Country Setting Age(s) Study Size Primary Screen Secondary Screen Diagnosis NNS |

|---------------------------------------------------------------------------------------------------------------------------------------------|

71. | 2009 McAdam USA Urban NS 32108 TST NS 510 |

115. | 2009 Badiaga France Urban Adults & Children 221 sx CXR Sm Cx CXR Sm Cx 111 |

142. | 2008 Romaszko Poland Multiple Adults only 3004 CXR CXR Sm Cx Clinical Other 137 |

218. | 2006 Lofy USA Urban NS 425 sx CXR TST Sm Cx CXR Sm Cx 33 |

264. | 2005 Valin France Urban Adults only 1360 CXR CXR Sm Cx Clinical 25 |

|---------------------------------------------------------------------------------------------------------------------------------------------|

290. | 2003 Mc Elroy USA Urban Adults only 620 TST CXR CXR Sm Cx Clinical 310 |

310. | 2001 Solsona Spain Urban Adults only 447 CXR TST Sm Cx 90 |

342. | 1999 Kimerling USA Urban Adults only 127 sx TST Sm Cx Sm Cx 32 |

343. | 1999 Southern USA Urban Adults & children 1943 sx CXR TST CXR Sm Cx Clinical 195 |

369. | 1997 Lau Australia Urban Adults only 3555 CXR CXR CXR Sm Cx 1778 |

|---------------------------------------------------------------------------------------------------------------------------------------------|

456. | 1986 Barry USA Urban Adults only 586 sx CXR TST CXR Sm Cx 196 |

458. | 1986 Capewell United Kingdom Urban Adults only 8956 CXR CXR Sm Cx 94 |

460. | 1985 Patel United Kingdom Urban Adults only 9132 CXR CXR Sm Cx 69 |

461. | 1984 Glicksman USA Urban Adults only 198 sx TST NS 22 |

506. | 1977 Ross United Kingdom NS Adults only 2809 CXR CXR Cx 23 |

|---------------------------------------------------------------------------------------------------------------------------------------------|

567. | 1961 Chaves USA Urban Adults only 9000 CXR Sm NS 63 |

605. | 1954 Jones USA Urban Adults only 405 CXR CXR 46 |

+---------------------------------------------------------------------------------------------------------------------------------------------+

Prisons



2341 (19-2945) (N=17)*

184 (19-191)

(N=9)

67(7-153) (N=6)

198 (18-222)

(N=6)

+-----------------------------------------------------------------------------------------------------------------+

| Year Author Country Setting Study Size Primary Screen Secondary Screen Diagnosis NNS |

|-----------------------------------------------------------------------------------------------------------------|

147. | 2008 Mor Israel Multiple 368 sx TST CXR CXR Sm Cx Clinical Other 184 |

256. | 2005 Carbonara Italy Urban 448 TST CXR CXR Sm Cx 224 |

263. | 2005 Risser USA Urban 12651 CXR TST CXR . |

271. | 2004 Baillargeon USA Urban 336668 TST CXR Sm Cx Clinical 2571 |

296. | 2003 McLaughlin USA NS 294 sx CXR TST Sm Cx CXR Sm Cx 19 |

|-----------------------------------------------------------------------------------------------------------------|

356. | 1998 Tulsky USA NS 3352 sx TST CXR 1676 |

376. | 1997 Layton USA Urban 3933 sx CXR TST Sm Cx CXR Sm Cx 562 |

388. | 1996 Puisis USA Urban 126608 CXR CXR Sm Cx 2945 |

392. | 1996 Bergmire-Sweat USA NS 686 sx TST CXR CXR Sm Cx 69 |

410. | 1994 Martin Spain Urban 702 TST CXR CXR Sm Cx 37 |

|-----------------------------------------------------------------------------------------------------------------|

442. | 1989 Spencer USA Urban 2240 sx TST Sm Cx . |

504. | 1978 Stead USA Urban 1500 TST CXR CXR Sm Cx 150 |

540. | 1970 Abeles USA Urban 15000 CXR TST CXR 1000 |

580. | 1958 [no author] USA NS 1809 CXR CXR 201 |

591. | 1956 Meyers USA Urban 47342 CXR CXR Sm 183 |

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593. | 1956 Deakins USA Urban 3156 CXR CXR 64 |

596. | 1955 Chaucer USA NS 1001 CXR CXR 59 |

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. list pubyr authnm country shorturb basen primscrlist secscrlist dxlist nns if ptype=="26-IN-Prison" & inc09==2

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13. | 2010 Sanchez Brazil NS 622 sx CXR CXR Sm Cx 19 |

36. | 2010 Vierra Brazil Urban 397 sx Sm Cx 57 |

84. | 2009 Sanchez Brazil Urban 1696 sx CXR Sm Cx CXR Sm Cx Clinical Other 37 |

109. | 2009 Lemos Brazil Multiple 237 sx TST CXR Sm Cx Clinical Other 40 |

184. | 2008 Wong Hong Kong NS 159017 sx CXR CXR Sm Cx Clinical 191 |

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212. | 2006 Abrahao Brazil NS 1052 sx TST Sm Cx Sm Cx 51 |

238. | 2006 Fournet Brazil NS 1633 sx CXR Sm Cx Sm Cx Other 22 |

247. | 2005 Sanchez Brazil Urban 1078 sx CXR TST Sm Cx CXR Sm Cx Clinical Other 34 |

258. | 2005 Leung Hong Kong Urban 814 sx CXR Sm Cx CXR Sm Cx Clinical Other 82 |

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| Year Author Country Setting Study Primary Secondary Diagnosis NNS |


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35. | 2010 Banu Bangladesh NS 11000 sx Sm Cx Sm Cx Clinical 45 |

49. | 2010 Mbondi Mfondih Cameroon Multiple 1617 Sm Other Sm 7 |

54. | 2010 Kazi Pakistan NS 364 sx Sm Cx 52 |

223. | 2006 Noeske Cameroon Urban 2474 sx Sm Sm Cx Clinical Other 42 |

281. | 2004 Rao Pakistan Urban 4870 sx CXR Sm CXR Sm Clinical 153 |

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305. | 2003 Shah Pakistan Urban 386 sx Sm Clinical 43 |

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73. | 2009 Okaru Kenya NS 3650 sx CXR Sm CXR Sm Cx Clinical 108 |

75. | 2009 Banda Malawi NS 7661 sx Sm Sm 142 |

198. | 2007 Habeenzu Zambia NS 6118 sx Sm Cx 25 |

286. | 2004 Harries Malawi NS 93877 sx Sm 222 |

375. | 1997 Koffi Cote d'Ivoire NS 1861 sx CXR Sm CXR Sm 18 |

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380. | 1997 Nyangulu Malawi NS 914 sx Sm CXR Sm 28 |

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Low Incidence

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High Incidence

Medium Incidence

Moderate Incidence

Drug & Alcohol users



119 (77-150)

(N=4)

5 (N=1)*

20(8-20)(N=2)

--

list pubyr authnm country shorturb shortage basen primscrlist secscrlist dxlist nns if ptype=="13-RG-Drugs/Alc" & inc09==1

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| Year Author Country Setting Age (s) Study Primary Secondary Diagnosis NNS|


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148. | 2008 Story United Kingdom Urban NS . CXR CXR Sm 140 |

261. | 2005 de Vries Netherlands NS Unknown 380 CXR CXR Sm Cx 76 |

349. | 1998 Sadeghi-Hassanabadi Iran NS Adults only 2093 TST CXR CXR Sm Cx Clinical 150 |

450. | 1987 Friedman USA Urban Adults only 970 sx CXR TST CXR Sm Cx 108 |

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. list pubyr authnm country shorturb shortage basen primscrlist secscrlist dxlist nns if ptype=="13-RG-Drugs/Alc" & inc09==2

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| Year Author Country Setting Age(s) Study Size Primary Screen Diagnosis NNS |

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172. | 2008 Ruutel Estonia NS NS 112 TST IGRA NS . |

372. | 1997 Yoong Malaysia Urban Adults only 49 sx CXR CXR Sm Cx 5 |

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4. | 2010 Kiria Georgia Urban Adults only 3459 sx NS 20 |

166. | 2008 Poudyal Nepal NS Adults only 86 sx Sm Sm Clinical 8 |

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DiabetesWeighted Mean NNS (Range) (# studies)


57 (28-71)(N=3)

2222

(N=1)

29(25-37)(N=2)

45 (17-54)(N=3)


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DIABETES


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401. | 1995 Kim South Korea Urban Adults only 8015 CXR CXR Sm Cx 2223 |

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307. | 2002 Ezung India Urban Adults only 100 sx CXR Sm CXR Sm 38 |

470. | 1984 Tripathy India Urban Adults only 219 Sm Sm 25 |

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106. | 2009 Webb South Africa Urban Children only 258 sx CXR TST Sm Cx Other CXR Sm Cx 37 |

466. | 1984 Gill South Africa Urban Adults only 66 CXR CXR Sm 17 |

468. | 1984 Lester Ethiopia Urban Adults only 427 CXR CXR Sm Cx 54 |

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Moderate Incidence



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Medium Incidence

High Incidence

Populations Ripe for Screening:TBD

Who to screen?Case Finding “Tree”

• Tree tops (Not out of reach)

– Community wide (door-to-door, mobile units – ECF?)• D2D finds harder to reach patients

• Mid-range branches (high yield; mod access)

– HIV-infected populations “in the population”

• Low hanging branches (mod/low yield; ? access)

– Diabetics, (Alcoholics/drug users/smokers)

• Low hanging fruit (mod/high yield; mod access)

– Contacts; HIV-infected populations (many SM-; need culture?)

• Fallen fruit (mod/high yield; easy access)

– Prisons; pMTCT; VCT

Studies that we like…

• Contacts contacts contacts

• Community – if done right and in the right place

• HIV-infected populations

Systematic review/meta-analysis of TB in close contacts

4.5% yield for all TB

2.3% for bact confirmed

Morrison J et al, Lancet ID 2008

Greatest yield in

children < 5

ACF-HH: Active Case-Finding in Household Contacts of TB patients in South Africa

• Index patients (N=723) identified from hospital or clinic

• Household contacts screened for TB & HIV

• Single sputum (regardless of symptoms)

– AFB smear

– Culture (MGIT)

– Drug susceptibility testing

• TB dxed in contacts: 94% sm- cx+

• Prevalence in HH contacts ~8x higher than in households without a known TB case

• Of contacts receiving VCT, 10% HIV+

2812 HH Contacts enrolled

2146 (76%) gave sputum

164 (8%) TB dx

95 (58%) Confirmed M.tb69 (42%) Probable

1,982 (92%) TB neg

666 (24%) did not give sputum

60 (9%) on TB rx

AE Shapiro et al. AIDS 2010, Late breaker, Abstract #FRLBC106

Community randomized trial of enhanced DOTS for tuberculosis control in Rio de Janeiro, Brazil

• DOTS vs DOTS-ampliado

– DOTS + Contact investigation

• 960 contacts identified

– 699 screened

– 24 (4%) had active TB

– 258 (27%) started on IPT

Cavalcante et al., Int J Tuberc Lung Dis 2010;14:203-9

DetecTB

(Source: Dr EL Corbett, 2010)

Yield of Active Case Finding by 2

Methods in Harare, Zimbabwe

• Detection of cases

– Van = 255/5466

– D2D = 137/4711

• aRR 1.48 (1.11-1.96)

• Prevalence after 6

rounds

– Baseline 6.5/1000

– F/U 3.7/1000

• aRR 0.59 (0.40-0.89)

Corbett et al., Lancet 2010, epub

ZAMSTAR

• 24 communities in South Africa and Zambia

– Each community 25,000 – 50,000

• Designed to reduce TB prevalence through

– improved TB case finding by increased access to

TB diagnostics for symptomatic persons

– Household interventions for families of TB

patients, which include HIV testing and treatment,

TB screening, and IPT for contacts of TB cases

PIs: P. Godfrey-Faussett, H. Ayles, N. Beyers

Active case finding at clinics –

Open Access/Fast-track

Community-based active case finding

ZAMSTAR

Preliminary Results

• Baseline population surveys

– TB prevalence 900/100,000 in Zambia and 2,200/100,000 in South Africa!

• Enhanced Case Finding

– 15-26% of all TB cases in intervention communities detected by ECF

• Household evaluations

– >2-5% of households have secondary TB case

– ~50% contacts HIV tested

• HIV prevalence high - ~50%

• >50% HIV+ started on ART

• Final prevalence survey IN PROGRESS

Active TB Case-Finding as Part of HIV and pMTCTCare in Pregnant Women in Soweto

• 3,970 pregnant women were screened for TB at ANC clinics in Soweto between 12/08 to 8/09

• 1,492 (36%) were HIV-infected

• TB prevalence

– HIV-infected: 696 per 100,000 (10/1,492)

– HIV-uninfected: 200 per 100,000 (5/2,478)

• No cases of MDR-TB were identified

Gounder et al. CROI 2010. Session 180, Abstract 900.

Future Plans (for systematic review)

• GRADE

• Inclusion of foreign language papers

• Disaggregating papers with multiple studies

• Incorporating time-specific country TB incidence for stratification

• Separate children from adults

• Unweighted NNS; NNS excluding outliers

• Meta-analysis?

Current Limitations

• Non-inclusion of studies that found 0 cases in average NNS

– How and what is effect of inclusion/exclusion

• “double counting” some papers?

– e.g. HIV-positive prisoners could be in HIV or prisoners, or both

• Incident vs prevalent ACF

– Cross-sectional vs longitudinal

Future Research:What outcomes to measure?

• Hard outcomes: change in incidence, prevalence, mortality– Cases detected (easy), cases averted (modeling)

• Change in diagnostic delays: patient and health care delays– Treatment completion

• Head-to-head comparison of different strategies and diagnostics

• Operational research necessary– Cost-effectiveness of different strategies in different settings

Many thanks!


Tokunbo Akande

Ripa Chakravorty

Lois Eldred

Colleen Hanrahan

Darya Kizub

Meredith Mirrer

Maitreyi Sahu

WHO

Knut Lonnroth

Jacob Creswell

Mukund Uplekar

Final thoughts…

• Active/enhanced case finding is necessary to reduce TB incidence and TB transmission

• While research on best strategies/diagnostics are needed, no need to wait

• M & E of all strategies necessary

• Process factors acceptable, but measured impact desired

• Do it, but do it well…

What tools to use?How to best utilize new technology?

• Too many new diagnoses?– Can we handle the increase? Afraid to use the new tests?

• Operational and Implementation studies NEEDED– Specifically, of new diagnostics with old/new strategies

– Cost effectiveness

• Even if we diagnose more TB,– What is effect on patient outcomes?

– What is effect on TB epidemiology?

• In HIV-infected,– Symptom screen for high prevalence areas now recommended

• Needs to be validated in other settings

– Culture needed for diagnosis – too many SM negatives

Outside the HIV Clinic:Prevalence of Active TB with Case Finding in HIV-Infected

Populations

Population Studied

Setting Time

Period

Prevalence of Active TB

in Population

HIV+ Women in HIV MTCT

Program

(N=438)

Soweto

South

Africa

2001 13% OF TST+

3% overall

Patients in HIV Home Care

Program (N=441)

Phnom

Penh

2001 9% of patients

Adults in HIV VCT Program

(N=5000)

Cape

Town

2000-1 8% of HIV+

Adult residents of an urban

shantytown

(N=10,900)

Cite Soleil

Haiti

1991-2 6% of HIV+

2% of HIV–

Nachega 2003; Kimerling 2002; Coetzee 2005; Desourmeaux 1996

• Risk Groups:

– Sex workers

– MSM

– Child-focused studies

• Aspects of Case-Finding

– Long-term outcomes (treatment, adherence, retention in care, etc)

– Integrated vs. standalone case-finding programs

systematic review of number needed to screen (nns) in ... · jonathan e. golub center for...

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