Evidence map›Paper›PMID 35338834›Full record

SynthesisThe lancet. HIV2022

Tuberculosis screening among HIV-positive inpatients: 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, Ankur Gupta-Wright, Katherine Fielding and 13 more

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

Synthesis in The lancet. HIV, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed, 3 pooled it
7.6field-weighted citation impact, top 2% 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

29 citing papers in PubMed, 3 syntheses or guidelines pooled it, 40 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Trial
  5. 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
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  13. Tuberculosis and HIV coinfection: Progress and challenges towards reducing incidence and mortality.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2025
    Review
  14. Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

23 authors at 13 institutions in 8 countries.

Ashar DhanaDepartment of Medicine, University of Cape Town, Cape Town, South Africa.
Yohhei HamadaCentre for International Cooperation and Global TB 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, San Francisco, CA, USA.
Molebogeng X RangakaWellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Institute for Global Health, University College London, London, UK.
Tamara KredoNon-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
Annabel BaddeleyGlobal TB Programme, WHO, Geneva, Switzerland.
Cecily MillerGlobal TB Programme, WHO, Geneva, Switzerland.
Ankur Gupta-WrightInstitute for Global Health, University College London, London, UK; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
Katherine FieldingTB Centre, London School of Hygiene and Tropical Medicine, London, UK.
Robin WoodWellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Helena HuergaField Epidemiology Department, Epicentre, Paris, France.
Sekai Chenai Mathabire RückerField Epidemiology Department, Epicentre, Paris, France.
Christine HeidebrechtInstitute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.
Douglas WilsonDepartment of Internal Medicine, Edendale Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
Stephanie BjerrumResearch Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
Isik S JohansenResearch Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
Swe Swe ThitDepartment of Medicine, University of Medicine, Yangon, Myanmar.
Mar Mar KyiDepartment of Medicine, University of Medicine, Yangon, Myanmar.
Josh HansonThe Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
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, Faculty of Health Sciences, 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, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. Electronic address: gary.maartens@uct.ac.za.
University Of Medicine 1 Yangon · MMWorld Health Organization · CHLondon School of Hygiene & Tropical Medicine · GBOdense University Hospital · DKSan Francisco General Hospital · USSouth African Medical Research Council · ZATrillium Health Centre · CAUniversity of Cape Town · ZAUniversity of KwaZulu-Natal · ZAUniversity of Liverpool · GBUniversity of Southern Denmark · DKUNSW Sydney · AUWellcome Centre for Infectious Diseases Research in Africa · ZA

Funding

HIV-associated Tuberculosis Training Program (HATTP)D43TW010559 · FIC · UNIVERSITY OF CAPE TOWN · PI Graeme Ayton Meintjes · 2017 to 2026
$3.0M
FIC NIH HHS D43 TW010559Medical Research Council MR/R010161/1Wellcome TrustWellcome Trust 203135/Z/16/ZWellcome Trust 214321/Z/18/ZWorld Health Organization 001
6 · The paper itself

Abstract

backgroundSince 2011, WHO has recommended that HIV-positive inpatients be routinely screened for tuberculosis with the WHO four-symptom screen (W4SS) and, if screened positive, receive a molecular WHO-recommended rapid diagnostic test (eg, Xpert MTB/RIF [Xpert] assay). To inform updated WHO tuberculosis screening guidelines, we conducted a systematic review and individual participant data meta-analysis to assess the performance of W4SS and alternative screening tests to guide Xpert testing and compare the diagnostic accuracy of the WHO Xpert algorithm (ie, W4SS followed by Xpert) with Xpert for all HIV-positive inpatients.

methodsWe searched MEDLINE, Embase, and Cochrane Library from Jan 1, 2011, to March 1, 2020, for studies of adult and adolescent HIV-positive inpatients enrolled regardless of tuberculosis signs and symptoms. The separate reference standards were culture and Xpert. Xpert was selected since it is most likely to be the confirmatory test used in practice. We assessed the proportion of inpatients eligible for Xpert testing using the WHO algorithm; assessed the accuracy of W4SS and alternative screening tests or strategies to guide diagnostic testing; and compared the accuracy of the WHO Xpert algorithm (W4SS followed by Xpert) with Xpert for all. We obtained pooled proportion estimates with a random-effects model, assessed diagnostic accuracy by fitting random-effects bivariate models, and assessed diagnostic yield descriptively. This systematic review has been registered on PROSPERO (CRD42020155895).

findingsOf 6162 potentially eligible publications, six were eligible and we obtained data for all of the six publications (n=3660 participants). The pooled proportion of inpatients eligible for an Xpert was 90% (95% CI 89-91; n=3658). Among screening tests to guide diagnostic testing, W4SS and C-reactive protein (≥5 mg/L) had highest sensitivities (≥96%) but low specificities (≤12%); cough (≥2 weeks), haemoglobin concentration (<8 g/dL), body-mass index (<18·5 kg/m

interpretationThe W4SS and other potential screening tests to guide Xpert testing have suboptimal accuracy in HIV-positive inpatients. On the basis of these findings, WHO now strongly recommends molecular rapid diagnostic testing in all medical HIV-positive inpatients in settings where tuberculosis prevalence is higher than 10%.

fundingWorld Health Organization.

Indexed as

HIV InfectionsTuberculosisTuberculosis, PulmonaryAdolescentAdultHumansInpatientsPrevalenceSensitivity and Specificity

Identifiers

PMID35338834
PMCPMC8964502
OpenAlexW4221114263

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.