Evidence map›Paper›PMID 29650047›Full record

SynthesisBMC public health2018

Care Cascade for targeted tuberculosis testing and linkage to Care in Homeless Populations in the United States: a meta-analysis.

Andrea Parriott, Mohsen Malekinejad, Amanda P Miller, Suzanne M Marks, Hacsi Horvath, James G Kahn

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC public health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 2 pooled it
0.7field-weighted citation impact, top 31% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 1 country.

Andrea ParriottPhilip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA. andrea.parriott@ucsf.edu.
Mohsen MalekinejadPhilip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA.
Amanda P MillerPhilip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA.
Suzanne M MarksDivision of Tuberculosis Elimination, Centers for Disease Control and Prevention, Mailstop E-10, 1600 Clifton Road, Atlanta, GA, 30333, USA.
Hacsi HorvathPhilip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA.
James G KahnPhilip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA.
University of California, San Francisco · USCenters for Disease Control and Prevention · US

Funding

CDC HHS 5U38PS004649NCHHSTP CDC HHS U38 PS004649
6 · The paper itself

Abstract

backgroundHomelessness increases the risk of tuberculosis (TB) disease and latent TB infection (LTBI), but persons experiencing homelessness often lack access to testing and treatment. We assessed the yield of TB testing and linkage to care for programs targeting homeless populations in the United States.

methodsWe conducted a comprehensive search of peer-reviewed and grey literature, adapting Cochrane systematic review methods. Two reviewers independently assessed study eligibility and abstracted key data on the testing to care cascade: number of persons reached, recruited for testing, tested for LTBI, with valid test results, referred to follow-up care, and initiating care. We used random effects to calculate pooled proportions and 95% confidence intervals (CI) of persons retained in each step via inverse-variance weighted meta-analysis, and cumulative proportions as products of adjacent step proportions.

resultsWe identified 23 studies published between 1986 and 2014, conducted in 12 states and 15 cities. Among studies using tuberculin skin tests (TST) we found that 93.7% (CI 72.4-100%) of persons reached were recruited, 97.9% (89.3-100%) of those recruited had tests placed, 85.5% (78.6-91.3%) of those with tests placed returned for reading, 99.9% (99.6-100%) of those with tests read had valid results, and 24.7% (21.0-28.5%) with valid results tested positive. All persons testing positive were referred to follow-up care, and 99.8% attended at least one session of follow-up care. Heterogeneity was high for most pooled proportions. For a hypothetical cohort of 1000 persons experiencing homelessness reached by a targeted testing program using TST, an estimated 917 were tested, 194 were positive, and all of these initiated follow-up care.

conclusionsTargeted TB testing of persons experiencing homelessness appears effective in detecting LTBI and connecting persons to care and potential treatment. Future evaluations should assess diagnostic use of interferon gamma release assays and completion of treatment, and costs of testing and treatment.

Indexed as

Ill-Housed PersonsContinuity of Patient CareHumansLatent TuberculosisTuberculin TestTuberculosisUnited StatesAdultsHealth disparitiesHealth servicesHomelessnessPublic healthTargeted testingTuberculosisUnited States

Identifiers

PMID29650047
PMCPMC5897923
OpenAlexW2805447518

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.