Abstract
Aims What is the evidence base for the effectiveness of interventions to reduce tuberculosis (TB) incidence in countries which have low TB incidence?
Methods We conducted a systematic review of interventions for TB control and prevention relevant to low TB incidence settings (<10 cases per 100 000 population). Our analysis was stratified according to “direct” or “indirect” effects on TB incidence. Review quality was assessed using AMSTAR2 criteria. We summarised the strength of review level evidence for interventions as “sufficient”, “tentative”, “insufficient” or “no” using a framework based on the consistency of evidence within and between reviews.
Results We found sufficient review level evidence for direct effects on TB incidence/case prevention of vaccination and treatment of latent TB infection. We also found sufficient evidence of beneficial indirect effects attributable to drug susceptibility testing and adverse indirect effects (measured as sub-optimal treatment outcomes) in relation to use of standardised first-line drug regimens for isoniazid-resistant TB and intermittent dosing regimens. We found insufficient review level evidence for direct or indirect effects of interventions in other areas, including screening, adherence, multidrug-resistant TB, and healthcare-associated infection.
Discussion Our review has shown a need for stronger evidence to support expert opinion and country experience when formulating TB control policy.
Abstract
Whilst vaccination and treatment of latent TB infection are supported by review level evidence, there is a need for a stronger evidence base in other intervention areas to support decisions when formulating TB control policy in low-incidence countries. http://ow.ly/Y4vA50p4Hfv
Footnotes
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Provenance: Submitted article, peer reviewed.
Author contributions: D. Zenner conceptualised the initial hypothesis and idea for the study and provided overall supervision. S.M. Collin performed the database searches. S.M. Collin and M.C. Muzyamba screened references. S.M. Collin assessed study quality and extracted data. S.M. Collin and F. Wurie summarised and synthesised the data. S.M. Collin and D. Zenner drafted the paper with input from G. de Vries, K. Lönnroth, G.B. Migliori, I. Abubakar and S.R. Anderson. S.M. Collin had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors contributed to drafting the manuscript and reviewing it for important intellectual content. All authors approved the final manuscript.
Conflict of interest: S.M. Collin has nothing to disclose.
Conflict of interest: F. Wurie has nothing to disclose.
Conflict of interest: M.C. Muzyamba has nothing to disclose.
Conflict of interest: G. de Vries has nothing to disclose.
Conflict of interest: K. Lönnroth has nothing to disclose.
Conflict of interest: G.B. Migliori has nothing to disclose.
Conflict of interest: I. Abubakar has nothing to disclose.
Conflict of interest: S.R. Anderson has nothing to disclose.
Conflict of interest: D. Zenner has nothing to disclose.
Support statement: This study is part of the E-DETECT TB project (ref. 709624) which has received funding from the European Union's Health Programme (2014–2020). The content of this paper represents the views of the authors only and is their joint responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains. The study is within the remit of the research activities of the WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Tradate, Italy and of the Global Tuberculosis Network. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received December 4, 2018.
- Accepted March 22, 2019.
- Copyright ©ERS 2019.
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.