Tuberculosis Research and Treatment

Review Article

Yield and Coverage of Active Case Finding Interventions for Tuberculosis Control:A Systematic Review and Meta-analysis

Table 2

Meta-regression of Predictors of Yield of Active TB Cases following Active Case Finding Activities.


Predictors of yield proportion	Bivariable Anaylsis		Multivariable model 1: Screening and diagnosis separate		Multivariable model 2: Combined approach		Multivariable model 3: Diagnosis by GeneXpert MTB/RIF

Overall	Beta (95% CI)	P value	Beta (95% CI)	P value	Beta (95% CI)	P value	Beta (95% CI)	P value
Study design		0.08		0.42		0.36		0.67
Cross-sectional	Reference		Reference		Reference		Reference
Prospective	0.98 (-1.56 to 3.52)		-1.12 (-3.66 to 1.41)		-1.11 (-3.65 to 1.42)		-1.10 (-3.62 to 1.42)
RCT	0.96 (-2.82 to 4.74)		0.79 (-3.14 to 4.72)		1.00 (-2.92 to 4.93)		0.02 (-3.79 to 3.83)
Surveys	-3.55 (-7.36 to 0.27)		-2.66 (-6.43 to 1.10)		-2.51 (-6.26 to 1.24)		-2.04 (-5.73 to 1.64)
Retrospective chart review	4.74 (-0.46 to 9.94)		0.57 (-4.70 to 5.84)		1.52 (-3.81 to 6.85)		0.84 (-4.40 to 6.08)
Quasi RCT	-3.78 (-10.87 to 2.72)		-5.16 (-11.47 to 1.16)		-5.44 (-11.75 to 0.86)		-3.84 (-9.95 to 2.28)
WHO region		0.02		0.21		0.28		0.15
Africa	Reference		Reference		Reference		Reference
Americas	-1.2 (-7.67 to 5.26)		-3.37 (-10.52 to 3.77)		-3.18 (-10.37 to 4.00)		-2.29 (-9.44 to 4.86)
Eastern Mediterranean	-4.31 (-9.89 to 1.28)		-3.51 (-9.03 to 2.01)		-3.37 (-8.86 to 2.12)		-3.38 (-8.88 to 2.13)
S.E. Asia	-3.50 (-5.78 to -1.22)		-2.40(-4.93 to 0.13)		-2.11 (-4.63 to 0.41)		-2.54 (-4.88 to -0.19)
Western Pacific	5.21 (-2.80 to 13.22)		3.36 (-4.54 to 11.26)		3.45 (-4.30 to 11.19)		4.67 (-2.96 to 12.30)
Multi- regional	6.04 (-11.32 to 23.40)		6.92 (-9.80 to 23.64)		7.52 (-9.15 to 24.19)		5.99 (-10.76 to 22.74)
Recruitment setting		<0.001		0.12		0.10		0.26
Community based	Reference		Reference		Reference		Reference
Hospitals or clinics	5.73 (3.50 to 7.95)		2.37 (-1.18 to 5.92)		2.56 (-0.98 to 6.10)		2.09 (-1.44 to 5.62)
Prisons or residential facility	0.18 (-3.57 to 3.93)		0.31 (-5.56 to 6.18)		0.25 (-5.60 to 6.10)		1.24 (-4.74 to 7.22)
Workplaces	-0.23 (-4.23 to 3.78)		-2.32 (-8.30 to 3.67)		-2.25(-8.18 to 3.69)		-0.78 (-6.59 to 5.02)
Internally-displaced persons camps	11.65 (-0.63 to 23.92)		12.97 (-1.03 to 26.96)		13.04(-0.94 to 27.03)		11.96 (-2.05 to 25.97)
Type of population screened		<0.001		0.34		0.38		0.14
General population	Reference		Reference		Reference		Reference
Contacts	1.68 (-0.92 to 4.29)		-1.15 (-4.42 to 2.13)		-0.96 (-4.23 to 2.31)		0.16 (-3.31 to 3.00)
PLWH	7.52 (4.8 to 10.23)		3.60 (-0.75 to 7.95)		3.34 (-0.97 to 7.64)		4.85 (0.74 to 8.97)
High risk for TB exposure^a	-0.39 (-3.66 to 2.87)		0.74 (-4.55 to 6.03)		1.02 (-4.26 to 6.31)		-0.62 (-5.92 to 4.67)
High risk for active TB^b	2.09 (-1.33 to 5.51)		-0.17 (-4.82 to 5.16)		-0.05 (-5.03 to 4.94)		0.68 (-4.25 to 5.61)
Population age group		0.02		0.005		0.005		0.02
Adults	Reference		Reference		Reference		Reference
Adults and children	-0.61 (-3.19 to 1.98)		2.33 (-0.78 to 5.45)		2.22 (-0.90 to 5.35)		1.81 (-1.28 to 4.90)
Children only	4.13 (0.99 to 7.28)		5.71 (2.28 to 9.15)		5.61 (2.22 to 8.99)		4.76 (1.45 to 8.07)
Year of publication		0.58
2011 to 2016	Reference
2000 to 2010	1.06 (-1.43 to 3.55)
1980 to 1999	-0.88 (-4.66 to 2.90)
Study quality rating		0.97
High quality	Reference
Moderate quality	-1.51 (16.82 to 13.79)
Low quality	0.63 (-7.56 to 8.82)
Screening modality		0.01		0.08
Symptom screening	Reference		Reference
CXR	0.14 (-2.97 to 3.24)		1.95 (-1.61 to 5.52)
Lab Screening^c	4.16 (1.60 to 6.71)		3.66 (0.68 to 6.64)
TST	3.27 (-9.35 to 15.90)		-3.97 (-16.18 to 8.25)
Diagnostic modality		0.27		0.90
Microscopy	Reference
Culture &/or GeneXpert MTB/RI	1.68 (-0.87 to 4.22)		-0.40 (-3.02 to 2.22)
CXR	2.52 (-0.75 to 5.79)		0.21 (-3.00 to 3.42)
Combined screening and diagnostic algorithm		0.02				0.14
Symptom – Microscopy	Reference				Reference
Symptom – CXR	2.32 (-1.10 to 5.75)				0.03 (-3.37 to 3.43)
Symptom – Culture/Xpert	-0.03 (-2.96 to 2.90)				-1.05 (-3.92 to 1.82)
CXR – Culture/Xpert	0.62 (-3.25 to 4.49)				1.29 (-2.91 to 5.49)
Lab^c – Culture/Xpert	5.02 (1.74 to 8.30)				3.60 (0.08 to 7.28)
Other^d	1.97 (-2.84 to 6.79)				0.17 (-5.04 to 4.70)
Diagnostic test using GeneXpert MTB/RIF		0.19						0.25
GeneXpert MTB/RIF not used	Reference						Reference
GeneXpert MTB/RIF used	1.99 (-0.98 to 4.97)						-1.67 (-4.53 to 1.20)

^a High risk for TB exposure: health care worker, prisoner, refugee. ^b High risk for active TB: diabetes mellitus, pregnancy, miners. ^c Includes screening using AFB smear (94%), culture (71%), or GeneXpert MTB/RIF (8%) ^d Other = microscopy for screening and diagnosis (5), CXR for screening and diagnosis (5), CXR for screening then microscopy for diagnosis (2), TST for screening then culture for diagnosis (1), and microscopy for screening then CXR for diagnosis (2).