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 exposurea
-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 TBb
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 Screeningc
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)
Labc – Culture/Xpert
5.02 (1.74 to 8.30)
3.60 (0.08 to 7.28)
Otherd
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).