Enhancing Evidence Synthesis Efficiency: Leveraging Large Language Models and Agentic Workflows for Optimized Literature Screening.

Background: Public health events of international concern highlight the need for up-to-date evidence curated using sustainable processes that are accessible. In development of the Global Repository of Epidemiological Parameters (grEPI) we explore the performance of an agentic-AI assisted pipeline (GREP-Agent) for screening evidence which capitalizes on recent advancements in large language models (LLMs). Methods: In this study, the performance of the GREP-Agent was evaluated on a data set of 2000 citations from a systematic review on measles using four LLMs (GPT4o, GPT4o-mini, Llama3.1, and Phi4). The GREP-Agent framework integrates multiple LLMs and human feedback to fine-tune its performance, optimize workload reduction and accuracy in screening research articles. The impact on performance of each part of this Agentic-AI system is presented and measured by accuracy, precision, recall, and F1-score metrics. Results: The results show how each phase of the GREP-Agent system incrementally improves accuracy regardless of the LLM. We found that GREP-Agent was able to increase sensitivity across a broad range of open source and proprietary LLMs to 84.2%-88.9% after fine-tuning and to 86.4%-95.3% by varying workload reduction strategies. Performance was significantly impacted by the clarity of the screening questions and setting thresholds for optimized workload reduction strategies. Conclusions: The GREP-Agent shows promise in improving the efficiency and effectiveness of evidence synthesis in dynamic public health contexts. Further development and refinement of adaptable human-in-the-loop AI systems for screening literature are essential to support future public health response activities, while maintaining a human-centric approach.