Table 2.
Characteristics of studies included in the clinical review (N=18) and economic review (N=6)
| First author and Location | Population | Study years | Screening: strategy and tools | TB case definition | Sample/cohort* |
Outcomes OR Details of costing studies and costs collected | |
|---|---|---|---|---|---|---|---|
| Screen | PCF | ||||||
| Clinical review – general population observational studies | |||||||
| Abdurrahman 2016 Abuja, Nigeria |
Urban including slums | 2010-2014 | ACF: One off community health worker house-to-house symptom screen. Sputum collected for smear if symptoms. | Smear + Adult ≥18 years | 485 | 209 | Smear grade Symptom duration at diagnosis |
| den Boon 2008 Cape Town, South Africa |
2 suburbs | 2002-2005 | Prevalence survey: sputum smear and culture for all collected at health centres. | Smear or culture + Adult ≥15 years | 27 | 473 | Smear grade Treatment outcomes |
| Shargie 2006 Hadiya zone, Southern Ethiopia |
Rural 1 district | 2003 | Prevalence survey: symptoms and/or on TB treatment. Sputum collected for smear if +. | Smear + Adult ≥15 years | 13 | 24 | Symptom duration at treatment start |
| Gopi 2005 Tiiruvallur South India |
Rural and urban 1 sub-district | 2001-2003 | Prevalence survey: CXR and symptoms. Sputum collected for smear and culture if symptoms or abnormal CXR. | Smear + Adult ≥15 years | 243 | 1049 | Pre-treatment loss to follow-up |
| Balasubramanian 2004; Tiiruvallur South India |
Rural and urban 1 sub-district | 1998-2001 | Prevalence survey: CXR and symptoms. Sputum collected for smear and culture if symptoms or abnormal CXR. | Smear + Adult ≥15 years | 231 | 833 | Pre-treatment loss to follow-up |
| Santha 2003 Tiiruvallur South India |
Rural and urban 1 sub-district | 1999-2000 | Prevalence survey: CXR and symptoms. Sputum collected for smear and culture if symptoms or abnormal CXR. | Smear + | 96 | 330 | Smear grade Symptom duration at first contact with health services Treatment outcomes |
| Harper 1996 East Nepal |
Rural 8 districts | 1990-1993 | Likely ECF (unclear): outreach TB camps (diagnostic services) lasting 2-4 days with pre-camp publicity in areas away from health posts, with high TB burden or where community requested services. If symptomatic sputum collected at camps. 45 camps over 3 years. | Smear + New TB | 68 | 1306 | Treatment outcomes |
| Cassels1982 East Nepal |
Rural 1 district | 1978-1980 | ACF: one-off house-to-house symptom screen by vaccinators. Pots left for sputum collection if symptoms, with drop-off at designated centres within 20 minutes walking distance. | Smear + | 111 | 159 | Treatment outcomes |
| Clinical review – general population cluster randomised trials | |||||||
| Shargie 2006 Hadiya Zone Southern Ethiopia |
Rural 2 districts | 2003-2004 | ECF: x1/month for 12 months IEC activities by community promoters¶ encouraging those with symptoms to attend monthly diagnostic outreach clinic where sputum collected for smear. | Smear + | 159 | 221 | Treatment outcomes |
| Clinical review – risk groups observational studies | |||||||
| Shewade 2019ʃ 18 districts in 7 states across India |
Marginalised/vulnerable populationsŦ | 2016-2017 | ACF: one-off community volunteer house-to-house symptom screen. Referral for sputum smear if symptoms. | Smear + Adult ≥15 years | 275 | 297 | Smear grade Treatment outcomes |
| Shewade 2019ʃ 18 districts in 7 states across India |
Marginalised/vulnerable populationsŦ | 2016-2017 | ACF: one-off community volunteer house-to-house symptom screen. Referral for sputum smear if symptoms. | Smear + Adult ≥15 years | 234 | 231 | Duration of symptoms to 1) first contact with health services; 2) diagnosis Time between diagnosis and treatment start Time between symptoms and treatment start |
| Paiao 2016 Mato Grosso do Sul state, Brazil |
Prisoners in 12 prisons | 2013-2014 | ACF: x2 symptom screen (at baseline and 1 year later). Sputum collected if symptoms. | Culture + Adult ≥18 years | 40 | 53 | Smear positivity of culture confirmed TB patients |
| Story 2012 London, UK |
Homeless people, drug users, asylum seekers, prisoners | 2005-2010 | ACF: mobile CXR screening programme. Screening in community settings where hard to reach people can be accessed (e.g. hostels, day centres, drug treatment services, prisons). | Culture + Age >15 years | 23 | 146 | Smear positivity of culture confirmed TB patients |
| Verver 2001 Netherlands |
Migrants | 1993-1998 | ACF: entry and every 6 months for 2 years CXR screening programme. Sputum for smear and culture if abnormal CXR. | Smear or culture + Stay <30 months | 454 | 368 | Smear positivity of culture confirmed TB patients Symptom duration at diagnosis Treatment outcomes |
| Churchyard 2000 Free State, South Africa |
Miners in 1 company | 1993-1997 | ACF: annual miniature CXR screening programme. Standard CXR and sputum for smear and culture if abnormal. | Culture + Known HIV status and treatment outcome | 1225 | 1011 | Treatment outcomes |
| Capewell 1986 Edinburgh, UK |
Hostel dwellers | 1976-1982 | ACF: x2/year miniature CXR screening programme, with monetary incentive. Referred to clinic if abnormal CXR. | Culture + | 42 | 26 | Smear positivity of culture confirmed TB patients |
| Clinical review – risk groups cluster randomised trials | |||||||
| Jenum 2018 Palamaner in Andhra Pradesh, South India |
Neonates receiving BCG by 72 hours of birth | 2006-2010 | ACF: x2/month for 2 years, home visits with screens for symptoms, TB exposure and failure to thrive. Referral with reminders to study medical ward for work up if +. | n/a | 2215† | 2167† | Mortality – all cause |
| Fox 2018, 70 districts in 8 provinces of Vietnam |
Household contacts in rural and urban areas | 2010-2015 | ACF: CXR and symptom screen at 0, 6, 12 and 24 months by National TB programme staff at district clinics. Sputum for smear and culture if symptoms or abnormal CXR | n/a | 10069† | 15638† | Mortality – all cause |
| Economic review | |||||||
| Muniyandi 2020 India |
General population (rural) | 2016-2018 | Prevalence survey: house-to house screening with symptoms and CXR. Sputum for smear and culture if symptoms or abnormal CXR. | Adult ≥15 years with TB | 110 | 226 | Empirical; CA from patient perspective; Primary costing data; 2018 cost reference year Diagnosis costs - Direct (medical and non-medical); Indirect – no input information Treatment costs - Direct (medical and non-medical); indirect – no input information |
| Gurung 2019 Nepal |
OPD attendees; social contacts of TB patients; general population (rural); | 2018 | ACF: Symptom screen in OPD; symptom screen social contacts; general population TB camp with community health worker house-to-house symptom screen 1-2 days before. Sputum for Xpert if symptoms. | Adult ≥15 years with PTB between 2-12 weeks of treatment | 50 | 49 | Empirical; CA from patient perspective; Primary costing data; 2018 cost reference year Pre-treatment costs:Direct medical – consultation, x-ray, lab tests, drugs, other; Direct non-medical – transport, food; Indirect – time loss, income loss intensive phase treatment costs:Direct medical – consultation, x-ray, drugs; Direct non-medical – transport, food; Indirect – time loss, income loss |
| Hussain 2019 Pakistan |
Private clinic attendees; general population (urban) | 2011-2012 | ACF: HCW incentives; symptom screen clinic attendees; ECF: TB IEC to general population. Sputum for smear/Xpert and CXR if symptoms. | TB patients on treatment for at least 2 months | 84 | 45 | Decision modelling; CEA from provider and patient perspective; Primary and secondary costing data; 2012 cost reference year Pre-diagnosis costs: Direct medical – consultation, tests, drugs; Direct non-medical – food and transport Diagnosis costs:Direct medical – consultation, tests, drugs; Direct non-medical – food and transport Treatment costs:Direct medical – consultation, tests, drugs; Direct non-medical – food and transport Indirect costs – lost earnings |
| Shewade 2018 India |
Marginalised and vulnerable populationsŦ | 2016-2017 | ACF: one-off community volunteer house-to house symptom screen. Referral for sputum smear if symptoms. | Smear + Adult ≥15 years newly registered for treatment | 234 | 231 | Empirical; CA from patient perspective; Primary costing data; 2018 cost reference year Diagnosis costs:Direct medical – consultation, drugs, tests; Direct non-medical – travel; Indirect – wages/income lost |
| Morishita 2016 Cambodia |
Household and neighbourhood contacts of smear + TB patients | 2014 | ACF: all household and symptomatic neighbourhood contacts invited for CXR screening on a specific date. Sputum for Xpert if abnormal CXR or symptoms. | New PTB with cured or completed treatment outcome | 108 | 100 | Empirical; CA from patient perspective; Primary costing data; 2014 cost reference year Pre-treatment costs: Direct medical – administration, tests, x-ray, drugs, hospitalisation; Direct non-medical – transport, food, guardian, insurance reimbursement; Indirect – lost income from health seeking and sick leave Treatment costs: Direct medical –hospitalisation; Direct non-medical – transport (DOTS, drug pick-up, follow-up visits), supplemental food, guardian/care giver, interest for borrowed money, insurance re-imbursement; Indirect – lost income (patient, guardian/care giver), reduced household activity, value lost from sold property |
| Sekandi 2015 Uganda |
General population (urban) | 2012 | Prevalence survey: house-to-house symptom screen. Sputum collection if symptoms for smear/culture. | Adult ≥15 years on at least 2 weeks of TB treatment | 103 | Decision modelling; CEA from societal perspective; Primary and secondary costing data; 2013 cost reference year Diagnosis costs: Direct non-medical - transportation, food, care giver, child care/hired help; Indirect – patient and care giver time lost |
|
⁎
number of people with TB unless otherwise indicated; PCF=passive case-finding; ACF=active case-finding; + = positive; CXR=chest radiograph; ECF=enhanced case finding; IEC=information, education and communication
¶
community-promoters - individuals with previous experience in community outreach activities who are provided training about TB).
Ŧ
includes slums, tribal areas, scheduled caste communities, areas where occupational lung diseases is high, areas where individuals with high risk of acquiring TB reside including stone crushing/mining/weaving industry/unorganized labour (construction workers etc)/homeless, high HIV/AIDS burden areas, areas or communities with high TB incidence (including prisons) and among household contacts of sputum smear positive TB patients.
ʃ
Papers report different outcomes on the same study participants; BCG=Bacillus Calmette–Guérin; n/a=not applicable.
†
total number in screened and passive case-finding group; CA=cost analysis; OPD=outpatient department; PTB=pulmonary TB; x-ray=radiography; HCW=health care worker; CEA=cost effectiveness analysis; DOTS=Directly Observed Treatment, Short-course.