RT Journal Article
SR Electronic
T1 Effectiveness of interventions for reducing TB incidence in countries with low TB incidence: a systematic review of reviews
JF European Respiratory Review
JO EUROPEAN RESPIRATORY REVIEW
FD European Respiratory Society
SP 180107
DO 10.1183/16000617.0107-2018
VO 28
IS 152
A1 Simon M. Collin
A1 Fatima Wurie
A1 Morris C. Muzyamba
A1 Gerard de Vries
A1 Knut Lönnroth
A1 Giovanni Battista Migliori
A1 Ibrahim Abubakar
A1 Sarah R. Anderson
A1 Dominik Zenner
YR 2019
UL http://err.ersjournals.com/content/28/152/180107.abstract
AB 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.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