背景:寻找耐药结核病(DR-TB)患者对于控制大流行和改善患者临床预后非常重要。据我们所知,评估有效性的系统评价,成本效益,可接受性,以及不同的DR-TB病例发现策略为研究提供信息的可行性,政策,和实践,尚未进行,初步研究的范围未知。
目的:因此,我们评估了有关DR-TB病例发现策略的现有文献。
方法:我们研究了系统评价,试验,定性研究,诊断测试准确性研究,以及其他旨在改善DR-TB病例检测的主要研究。我们排除了包括寻求结核病(TB)症状的患者的研究,已经诊断为结核病的患者,或者是基于实验室的。我们搜索了MEDLINE的学术数据库,Embase,科克伦图书馆,非洲信息,CINAHL(护理和相关健康文献累积指数),认识论,和PROSPERO(国际前瞻性系统审查登记册),没有语言或日期限制。我们筛选了标题,摘要,和全文一式两份。在Excel(微软公司)中进行数据提取和分析。
结果:我们筛选了3646篇标题和摘要以及236篇全文文章。我们确定了6项系统评价和61项主要研究。五篇评论描述了接触调查的成果,并侧重于家庭接触,航空公司联系人,药物敏感结核病和DR-TB接触之间的比较,以及索引病例和接触者之间DR-TB谱的一致性。一篇综述比较了通用和选择性耐药性测试。主要研究描述了(1)34项接触调查,(2)17次疫情调查,(3)3航空公司联系调查,(4)5项流行病学分析,(5)1个公私合作计划,和(6)电子注册程序。主要研究均为描述性研究,包括项目数据的横断面和回顾性综述。没有确定试验。由于相关信息的报告不完整,很难从接触调查中提取数据。
结论:可以更新现有的描述性评论,但是对有效性缺乏了解,成本效益,可接受性,以及为政策和实践提供信息的DR-TB病例发现策略的可行性。还需要术语的标准化,设计,和报告DR-TB病例发现研究。
BACKGROUND: Finding individuals with drug-resistant tuberculosis (DR-TB) is important to control the pandemic and improve patient clinical outcomes. To our knowledge, systematic reviews assessing the effectiveness, cost-effectiveness, acceptability, and feasibility of different DR-TB case-finding strategies to inform research, policy, and practice, have not been conducted and the scope of primary research is unknown.
OBJECTIVE: We therefore assessed the available literature on DR-TB case-finding strategies.
METHODS: We looked at systematic reviews, trials, qualitative studies, diagnostic test accuracy studies, and other primary research that sought to improve DR-TB case detection specifically. We excluded studies that included patients seeking care for tuberculosis (TB) symptoms, patients already diagnosed with TB, or were laboratory-based. We searched the academic databases of MEDLINE, Embase, The Cochrane Library, Africa-Wide Information, CINAHL (Cumulated Index to Nursing and Allied Health Literature), Epistemonikos, and PROSPERO (The International Prospective Register of Systematic Reviews) using no language or date restrictions. We screened titles, abstracts, and full-text articles in duplicate. Data extraction and analyses were carried out in Excel (Microsoft Corp).
RESULTS: We screened 3646 titles and abstracts and 236 full-text articles. We identified 6 systematic reviews and 61 primary studies. Five reviews described the yield of contact investigation and focused on household contacts, airline contacts, comparison between drug-susceptible tuberculosis and DR-TB contacts, and concordance of DR-TB profiles between index cases and contacts. One
review compared universal versus selective drug resistance testing. Primary studies described (1) 34 contact investigations, (2) 17 outbreak investigations, (3) 3 airline contact investigations, (4) 5 epidemiological analyses, (5) 1 public-private partnership program, and (6) an e-registry program. Primary studies were all descriptive and included cross-sectional and retrospective reviews of program data. No trials were identified. Data extraction from contact investigations was difficult due to incomplete reporting of relevant information.
CONCLUSIONS: Existing descriptive reviews can be updated, but there is a dearth of knowledge on the effectiveness, cost-effectiveness, acceptability, and feasibility of DR-TB case-finding strategies to inform policy and practice. There is also a need for standardization of terminology, design, and reporting of DR-TB case-finding studies.