TY - JOUR 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 DO - 10.1183/16000617.0107-2018 VL - 28 IS - 152 SP - 180107 AU - Simon M. Collin AU - Fatima Wurie AU - Morris C. Muzyamba AU - Gerard de Vries AU - Knut Lönnroth AU - Giovanni Battista Migliori AU - Ibrahim Abubakar AU - Sarah R. Anderson AU - Dominik Zenner Y1 - 2019/06/30 UR - http://err.ersjournals.com/content/28/152/180107.abstract N2 - 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 ER -