ReviewPublic health action2022
Missed opportunities for diagnosis and treatment in patients with TB symptoms: a systematic review.
Review in Public health action, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
What it found
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Who cites it
22 citing papers in PubMed.
- Qualitative study of patient experiences of mental distress during TB investigation and treatment in Zambia.BMC psychology · 2022Trial
- Towards ending tuberculosis in South Africa: an uncertainty analysis of the programmes and factors most critical to future declines.Global health action · 2026Article
- Frontline healthcare worker barriers impacting tuberculosis service demand and access in high burden settings: a scoping review.Journal of global health · 2026Article
- Reappraising TB preventive treatment in India: programmatic and ethical implications of subclinical tuberculosis in household contacts.The Lancet regional health. Southeast Asia · 2026Review
- Factors contributing to low tuberculosis diagnosis among children aged 0-14 years in Gem Sub County in Siaya County, Kenya.PloS one · 2026Article
- Active TB case finding in returnee coalminers and their home district communities in Pakistan.Public health action · 2025Article
- Informing People-Centered Target Product Profiles for TB Diagnostics: A Multi-Country Qualitative Study.medRxiv : the preprint server for health sciences · 2025Article
- Understanding treatment initiation pathways and associated costs among people with pulmonary tuberculosis in a peri-urban area of Mozambique: a cross-sectional study.BMC public health · 2025Article
- Unrecognized Tuberculosis: Risk Factors for Smear-Positive/Cavitary Asymptomatic Cases.Open forum infectious diseases · 2025Article
- Tuberculosis screening among cough suppressant buyers in pharmacies and drug outlets in Guinea: a cross-sectional study.BMJ open respiratory research · 2024Article
- An Effective Health System Approach to End TB: Implementing the Double X Strategy in Vietnam.Global health, science and practice · 2024Article
- Missed opportunities for TB diagnostic testing among people living with HIV in Zimbabwe: Cross-sectional analysis of the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) survey 2015-16.Journal of clinical tuberculosis and other mycobacterial diseases · 2024Article
- Presence of tuberculosis symptoms among HIV-positive men who have sex with men (MSM) in Zimbabwe.AIDS research and therapy · 2024Article
- Individual journeys to tuberculosis care in Nigeria's private sector during the COVID-19 pandemic.BMJ global health · 2024Article
- Accuracy of digital chest x-ray analysis with artificial intelligence software as a triage and screening tool in hospitalized patients being evaluated for tuberculosis in Lima, Peru.PLOS global public health · 2024Article
- The TB Surge intervention: an optimized approach to TB case-finding in Nigeria.Public health action · 2023Article
- Yield of Facility-based Targeted Universal Testing for Tuberculosis With Xpert and Mycobacterial Culture in High-Risk Groups Attending Primary Care Facilities in South Africa.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- The in-hospital tuberculosis diagnostic cascade and early clinical outcomes among people living with HIV before and during the COVID-19 pandemic - a prospective multisite cohort study from Ghana.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2023Article
- Reasons for missed opportunities to screen and test for TB in healthcare facilities.Public health action · 2022Article
- Developing and Validating an Individual-Level Deprivation Index for Children's Health in France.International journal of environmental research and public health · 2022Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
backgroundThe identification of patients with symptoms is the foundation of facility-based TB screening and diagnosis, but underdiagnosis is common. We conducted this systematic review with the hypothesis that underdiagnosis is largely secondary to patient drop out along the diagnostic and care pathway.
methodsWe searched (up to 22 January 2019) MEDLINE, Embase, and Cinahl for studies investigating patient pathway to TB diagnosis and care at health facilities. We used Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) to assess risk of bias. We reported proportions of patients with symptoms at each stage of the pathway from symptom screening to treatment initiation.
resultsAfter screening 3,558 abstracts, we identified 16 eligible studies. None provided data addressing the full cascade of care from clinical presentation to treatment initiation in the same patient population. Symptom screening, the critical entry point for diagnosis of TB, was not done for 33-96% of participants with symptoms in the three studies that reported this outcome. The proportion of attendees with symptoms offered a diagnostic investigation (data available for 15 studies) was very low with a study level median of 38% (IQR 14-44, range 4-84).
conclusionsInefficiencies of the TB symptom screen-based patient pathway are a major contributor to underdiagnosis of TB, reflecting inconsistent implementation of guidelines to ask all patients attending health facilities about respiratory symptoms and to offer diagnostic tests to all patients promptly once TB symptoms are identified. Better screening tools and interventions to improve the efficiency of TB screening and diagnosis pathways in health facilities are urgently needed.
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