Evidence map›Paper›PMID 34800394›Full record

SynthesisThe Lancet. Infectious diseases2022

Tuberculosis screening among ambulatory people living with HIV: a systematic review and individual participant data meta-analysis.

Ashar Dhana, Yohhei Hamada, Andre P Kengne, Andrew D Kerkhoff, Molebogeng X Rangaka, Tamara Kredo, Annabel Baddeley, Cecily Miller, Satvinder Singh, Yasmeen Hanifa and 44 more

Erratum issuedOpen access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Lancet. Infectious diseases, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 58 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
58citing papers in PubMed, 7 pooled it
3.1field-weighted citation impact, top 7% 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

58 citing papers in PubMed, 7 syntheses or guidelines pooled it, 68 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Subclinical tuberculosis: a meta-analysis of prevalence and scoping review of definitions, prevalence and clinical characteristics.European respiratory review : an official journal of the European Respiratory Society · 2024
    Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Evaluation of C-Reactive Protein and Computer-Aided Analysis of Chest X-rays as Tuberculosis Triage Tests at Health Facilities in Lesotho and South Africa.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024
    Trial
  9. Trial
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

54 authors at 20 institutions in 13 countries.

Ashar DhanaDepartment of Medicine, University of Cape Town, Cape Town, South Africa.
Yohhei HamadaCentre for International Cooperation and Global Tuberculosis Information, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Institute for Global Health, University College London, London, UK.
Andre P KengneNon-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
Andrew D KerkhoffDivision of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA.
Molebogeng X RangakaWellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Institute for Global Health, University College London, London, UK.
Tamara KredoCochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
Annabel BaddeleyGlobal Tuberculosis Programme, World Health Organization, Geneva, Switzerland.
Cecily MillerGlobal Tuberculosis Programme, World Health Organization, Geneva, Switzerland.
Satvinder SinghGlobal HIV, Hepatitis and STIs Programme, World Health Organization, Geneva, Switzerland.
Yasmeen HanifaTB Centre, London School of Hygiene & Tropical Medicine, London, UK.
Alison D GrantTB Centre, London School of Hygiene & Tropical Medicine, London, UK; Africa Health Research Institute, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Katherine FieldingTB Centre, London School of Hygiene & Tropical Medicine, London, UK.
Dissou AffolabiLaboratoire de Référence des Mycobactéries, Cotonou, Benin.
Corinne S MerleUNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland.
Ablo Prudence WachinouNational Hospital for Tuberculosis and Pulmonary Diseases, Cotonou, Benin.
Christina YoonDepartment of Medicine, Division of Pulmonary and Critical Care Medicine, Center for Tuberculosis, University of California, San Francisco, CA, USA.
Adithya CattamanchiDepartment of Medicine, Division of Pulmonary and Critical Care Medicine, Center for Tuberculosis, University of California, San Francisco, CA, USA.
Christopher J HoffmannJohns Hopkins University School of Medicine, Baltimore, MD, USA.
Neil MartinsonPerinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Johns Hopkins University Center for Tuberculosis Research, Baltimore, MD, USA.
Eyongetah Tabenyang MbuBamenda Regional Hospital HIV Treatment Center, Bamenda, Cameroon.
Melissa S SanderTuberculosis Reference Laboratory Bamenda, Bamenda, Cameroon.
Taye T BalchaClinical Infection Medicine, Lund University, Malmö, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden.
Sten SkogmarDepartment of Translational Medicine, Lund University, Malmö, Sweden.
Byron W P ReeveDSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa.
Grant TheronDSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa.
Gcobisa NdlangalavuDSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa.
Surbhi ModiUS Centers for Disease Control and Prevention, Atlanta, GA, USA.
Joseph CavanaughUS Centers for Disease Control and Prevention, Atlanta, GA, USA.
Susan SwindellsUniversity of Nebraska Medical Center, Omaha, NE, USA.
Richard E ChaissonJohns Hopkins University Center for Tuberculosis Research, Baltimore, MD, USA.
Faiz Ahmad KhanMcGill International Tuberculosis Centre, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
Andrea A HowardICAP at Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Robin WoodFaculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Swe Swe ThitDepartment of Medicine, University of Medicine 2, Yangon, Yangon Division, Myanmar.
Mar Mar KyiDepartment of Medicine, University of Medicine 2, Yangon, Yangon Division, Myanmar.
Josh HansonThe Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
Paul K DrainDepartment of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
Adrienne E ShapiroDepartment of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA.
Tendesayi KufaSchool of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa.
Gavin ChurchyardSchool of Public Health, University of the Witwatersrand, Johannesburg, South Africa; The Aurum Institute, Parktown, South Africa.
Duc T NguyenDepartment of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, USA.
Edward A GravissDepartment of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, USA.
Stephanie BjerrumDepartment of Clinical Research, Infectious Diseases, University of Southern Denmark, Odense, Denmark.
Isik S JohansenResearch Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
Jill K GershUniversity of Washington, Seattle, WA, USA.
David J HorneDepartment of Medicine, Division of Infectious Diseases, University of Washington, Seattle, WA, USA.
Sylvia M LaCourseDepartment of Medicine, Division of Infectious Diseases, University of Washington, Seattle, WA, USA; Department of Global Health, Division of Infectious Diseases, University of Washington, Seattle, WA, USA.
Haider Abdulrazzaq Abed Al-DarrajiCentre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia.
Adeeba KamarulzamanCentre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia.
Russell R KempkerDepartment of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
Nestani TukvadzeNational Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
David A BarrInstitute of Infection and Global Health, University of Liverpool, Liverpool, UK.
Graeme MeintjesDepartment of Medicine, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Gary MaartensDepartment of Medicine, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa. Electronic address: gary.maartens@uct.ac.za.
South African Medical Research Council · ZAUniversity of California, San Francisco · USUniversity of Washington · USWorld Health Organization · CHCenters for Disease Control and Prevention · USHouston Methodist · USJohns Hopkins University · USLondon School of Hygiene & Tropical Medicine · GBUniversity of Cape Town · ZAUniversity of Malaya · MYUniversity Of Medicine 1 Yangon · MMUniversity of Southern Denmark · DKAidjan-Lagos Corridor Organization · BJEmory University · USLund University · SEMcGill University Health Centre · CANational Center for Tuberculosis and Lung Disease · GEProgamme National Contre le Tuberculose · BJSpecial Programme for Research and Training in Tropical DiseasesUniversity of Bamenda · CM

Funding

Leadership and Operations Center (LOC), AIDS Clinical Trials Group (ACTG); LOC 1/UM1AI068636 · NIAID · UNIV OF NORTH CAROLINA CHAPEL HILL · PI Joseph J Eron, RAJESH T GANDHI · 2011 to 2026
$1073.1M
Aurum Clinical Trials UnitUM1AI154463 · NIAID · AURUM INSTITUTE NPC · PI Gavin John Churchyard · 2021 to 2026
$8.1M
Emory/Georgia TB Research Advancement Center (TRAC)P30AI168386 · NIAID · EMORY UNIVERSITY · PI Neel Rajnikant Gandhi, Jyothi Rengarajan · 2022 to 2026
$5.8M
Emory-Georgia TB Research Training ProgramD43TW007124 · FIC · EMORY UNIVERSITY · PI HENRY M BLUMBERG, Nestani Tukvadze · 2004 to 2026
$4.6M
HIV-associated Tuberculosis Training Program (HATTP)D43TW010559 · FIC · UNIVERSITY OF CAPE TOWN · PI Graeme Ayton Meintjes · 2017 to 2026
$3.0M
Novel clinic-based TB diagnostics and testing algorithms for persons with HIVK23AI140918 · NIAID · UNIVERSITY OF WASHINGTON · PI SHAPIRO, ADRIENNE E · 2019 to 2024
$937k
FIC NIH HHS D43 TW007124FIC NIH HHS D43 TW010559Medical Research Council MR/R010161/1NIAID NIH HHS K23 AI140918NIAID NIH HHS P30 AI168386NIAID NIH HHS UM1 AI068636NIAID NIH HHS UM1 AI154463Wellcome Trust 203135/Z/16/ZWellcome Trust 214321/Z/18/ZWorld Health Organization 001
6 · The paper itself

Abstract

backgroundThe WHO-recommended tuberculosis screening and diagnostic algorithm in ambulatory people living with HIV is a four-symptom screen (known as the WHO-recommended four symptom screen [W4SS]) followed by a WHO-recommended molecular rapid diagnostic test (eg Xpert MTB/RIF [hereafter referred to as Xpert]) if W4SS is positive. To inform updated WHO guidelines, we aimed to assess the diagnostic accuracy of alternative screening tests and strategies for tuberculosis in this population.

methodsIn this systematic review and individual participant data meta-analysis, we updated a search of PubMed (MEDLINE), Embase, the Cochrane Library, and conference abstracts for publications from Jan 1, 2011, to March 12, 2018, done in a previous systematic review to include the period up to Aug 2, 2019. We screened the reference lists of identified pieces and contacted experts in the field. We included prospective cross-sectional, observational studies and randomised trials among adult and adolescent (age ≥10 years) ambulatory people living with HIV, irrespective of signs and symptoms of tuberculosis. We extracted study-level data using a standardised data extraction form, and we requested individual participant data from study authors. We aimed to compare the W4SS with alternative screening tests and strategies and the WHO-recommended algorithm (ie, W4SS followed by Xpert) with Xpert for all in terms of diagnostic accuracy (sensitivity and specificity), overall and in key subgroups (eg, by antiretroviral therapy [ART] status). The reference standard was culture. This study is registered with PROSPERO, CRD42020155895.

findingsWe identified 25 studies, and obtained data from 22 studies (including 15 666 participants; 4347 [27·7%] of 15 663 participants with data were on ART). W4SS sensitivity was 82% (95% CI 72-89) and specificity was 42% (29-57). C-reactive protein (≥10 mg/L) had similar sensitivity to (77% [61-88]), but higher specificity (74% [61-83]; n=3571) than, W4SS. Cough (lasting ≥2 weeks), haemoglobin (<10 g/dL), body-mass index (<18·5 kg/m

interpretationC-reactive protein reduces the need for further rapid diagnostic tests without compromising sensitivity and has been included in the updated WHO tuberculosis screening guidelines. However, C-reactive protein data were scarce for outpatients on ART, necessitating future research regarding the utility of C-reactive protein in this group. Chest x-ray can be useful in outpatients on ART when combined with W4SS. The WHO-recommended algorithm has suboptimal sensitivity; Xpert for all offers slight sensitivity gains and would have major resource implications.

fundingWorld Health Organization.

Indexed as

Antibiotics, AntitubercularHIV InfectionsMycobacterium tuberculosisTuberculosisTuberculosis, PulmonaryAdolescentAdultChildCross-Sectional StudiesHumansProspective StudiesRifampinSensitivity and SpecificityAntibiotics, AntitubercularRifampin

Identifiers

PMID34800394
PMCPMC8942858
OpenAlexW3213157722

What OpenQuestion holds

Textmetadata
LicenceTDM
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.