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. 2019 May 29;28(152):180107.
doi: 10.1183/16000617.0107-2018. Print 2019 Jun 30.

Effectiveness of interventions for reducing TB incidence in countries with low TB incidence: a systematic review of reviews

Simon M Collin  1 , Fatima Wurie  2 , Morris C Muzyamba  2 , Gerard de Vries  3 , Knut Lönnroth  4 , Giovanni Battista Migliori  5 , Ibrahim Abubakar  6 , Sarah R Anderson  2 , Dominik Zenner  6
Affiliations

Effectiveness of interventions for reducing TB incidence in countries with low TB incidence: a systematic review of reviews

Simon M Collin et al. Eur Respir Rev. .

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.

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Conflict of interest statement

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.

Figures

FIGURE 1
FIGURE 1
Study selection (PRISMA flow diagram).
See this image and copyright information in PMC

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