Should systematic screening for active TB be done in household contacts and other close contacts?

Note: For full references to cited studies, see systematic review 1 (Kranzer K et al. A systematic literature review of the benefits to communities and
individuals of active screening for tuberculosis disease. International Journal of Tuberculosis and Lung Disease, 2013, 17:432–446.)
Summary of findings
Quality assessment
No of cases/population Effect Importance
Quality
No of studies Design Limitations Inconsistency Indirectness Imprecision Other Intervention Control Relative (95%CI) Absolute
1. Impact on case detection
Cross sectional studies assessing proportion of detected cases through screening vs. all notified cases
5 studies: Cross-sectional Not serious Not serious Serious 1 Not serious None IMPORTANT
Lee 2008 31 1635 2% of all notified cases
Ottmani 2009 NA NA 4.5% ≥10 years, 19% of <10 years VERY LOW
Capewell 1984 78 816 9% of all notified cases
Ormerod 1993 50 649 7% of all notified cases
Jereb 1999 561 9199 6% of all notified cases
2. Impact on time to diagnosis and severity at diagnosis:
2.1. Studies on delay: No studies
2.2. Studies of severity of disease at time of diagnosis
Proportion sputum smear positive in screening compared to passive case finding
IMPORTANT
1 (Eang 2012) Cross sectional Not serious Not serious Serious 2 Not serious 116/405(29%) 358/602(59%) 0.48(0.41;0.57) 31/100 fewer in screening (25-35 lower) LOW
Smear grade among sputum smear positive cases, reporting percentage scanty, proportion 2+ or 3+ out of all smear positive
1 (Eang 2012) Cross sectional Not serious Not serious Not serious Not serious 50/116(0.43) 203/354(0.57) 0.75(0.60;0.94) 14/100 fewer (3/100 to 23/100 fewer) LOW
Chest X-ray indicating severe disease
1 (Wang 2000) Cross sectional Not serious Not serious Serious 3 Not serious 17/284(6%) 620/3903(16%) 0.38 (0.23;0.60) 10/100 fewer severe (6-12/100 fewer) VERY LOW
3. Impact on treatment outcomes: no studies CRITICAL
4. Impact on TB epidemiology
Cluster RCT of screening of household TB contacts, including chemoprophylaxis for those with likely latent infection, over 5 years, in a high incidence area of Rio de Janeiro. Comparing TB notification in intervention and control areas
1 (Cavalcante Cluster RCT Not serious Only one study Serious 4 Serious 5 Incidence decr. Incidence increased 15% difference in change of incidence LOW
2010) 10%, from 339 to 5%from 340 to (p for difference=0.04)
305/100,0006 358/100,0005 CRITICAL
Cluster RCT of household intervention (3 visits per household, including screening of household contacts) vs. no household intervention in very high burden setting, comparing prevalence of active TB incidence of TB infection
1 (Ayles 2012)7 Cluster RCT Not serious Only one study Serious 8 Serious 9 TB prevalence TB prevalence Adj RR TB: 0.78 194 fewer prevalent TB cases/100,000 LOW
746/100,000 883/100,000 (0.61-1.00) in the intervention areas
Infection incidence Infection incidence Adj RR infection: 0.9 less TB infections/100 population in
0.87% 1.71% 0.45 (0.20-1.05) the intervention areas

1 The study design does not allow conclusion if detected cases are additional and the reported percentages are only indirect measures of increase in case detection
2 Only one study in one setting
3 Only one study in one setting.
4 Not possible to separate the effect of contact screening for active TB from the other co-interventions; treatment of latent TB. Only one study.
5 Borderline statistical significance
6 Absolute number of cases by year not reported.
7 The household intervention also included HIV counselling, testing and management. The study also included an arm of enhanced case finding, results are not included here
8 Not possible to separate the effect of contact tracing from the other co-interventions; treatment of latent TB, HIV counselling and testing. Only one study.
9 Borderline statistical significance for impact on prevalance of active TB and not statistically significant difference in TB infection prevalance
 Should systematic screening for active TB be done in miners?

Note: For full references to cited studies, see systematic review 1 (Kranzer K et al. A systematic literature review of the benefits to communities and
individuals of active screening for tuberculosis disease. International Journal of Tuberculosis and Lung Disease, 2013, 17:432–446.)
Summary of findings
Quality assessment
No of cases/population Effect
Importance
Quality
Other Relative
No of studies Design Limitations Inconsistency Indirectness Imprecision Intervention Control Absolute
considerations (95%CI)

1. Impact on case detection

No studies IMPORTANT
2. Impact on time to diagnosis and severity at diagnosis
No studies IMPORTANT
3. Impact on treatment outcomes
11 Cohort No No Serious 2 No - 12/1225 (1.0%) 69/1011 (6.8%) Adjusted RR: 5.5 fewer deaths per 100 treated ( 4.2 to VERY LOW CRITICAL
5.6(2.6-12.2) 6.3 fewer per 100 treated)
5. Impact on TB epidemiology
No studies CRITICAL

1 Churchyard 2000. Study population: miners.

2 Only one study
 Should systematic screening for active TB be done in prisoners?

Note: For full references to cited studies, see systematic review 1 (Kranzer K et al. A systematic literature review of the benefits to communities and
individuals of active screening for tuberculosis disease. International Journal of Tuberculosis and Lung Disease, 2013, 17:432–446.)
Summary of findings
Quality assessment
No of cases/population Effect
Importance
Quality
Other Relative
No of studies Design Limitations Inconsistency Indirectness Imprecision Intervention Control Absolute
considerations (95%CI)

1. Impact on case detection

No studies
2. Impact on time to diagnosis and severity at diagnosis
2.1. Studies of delay from reported onset of symptoms to start of treatment
1 Story 20081 Cross sectional Serious 2 Only one study Serious 3 Serious 4 - - 3 time longer - VERY LOW
average delay in
passive case IMPORTANT
finding group
2.2.Proportion sputum smear positive in screening compared to passive case finding
1 Story 2008 Cross sectional Serious Only one study Serious Serious4 44%4 66% 0.67 22/100 fewer in screening groups VERY LOW

3. Impact on treatment outcomes

2 studies Cross-sectional Serious 5 Not serious Serious5 Not serious VERY LOW CRITICAL
Koffi 1997 80/108=74% NA NA NA
Harries 2004 181/296=61%

5. Impact on TB epidemiology
1 study6 Longitudinal Serious 7 Only one study Serious 8 Serious 9 900/100,000 in 2,500/100,000 in 0.36 1600/100,000 notified cases less after ten VERY LOW CRITICAL
Yanjindulam 2012 surveillance prisons 2010 10 prisons in 2001 years implementation

1 This study screened hard-to-reach groups, including homeless, drug users, in shelters, and prisoners
2 Only a conference abstract is available so design details cannot be assessed.
3 The study did not report results separately for the different subgroups.
4 Absolute numbers not available
5None of the studies compared change in treatment success rate when introducing screening or through a trial design comparing screening vs. no screening.
6Yanjindulam 2012. Introduction of systematic screening at both detention and conviction combined with improved TB management and improved living conditions in the prisons, between 2001 and 2010, across 23 prisons and 16 detention

centres with a total of about 6000 prisoners. Assessed trend in TB notification within prisons and compared to national trend.
7 No control group, only compared before and after in prisons and with national trend during the same time period
8 Only one study in one setting. It is not possible to separate the impaxct of screening from the impact of improved living conditions and improved TB treatment.
9 Avaiable data do not allow calculation of statistical uncertainty.
10 Absolute numbers not reported
Stable national notification in same period
 Should systematic screening for active TB be done in people with previously untreated fibrotic CXR lesion?

Note: For full references to cited studies, see systematic review 1 (Kranzer K et al. A systematic literature review of the benefits to communities and
individuals of active screening for tuberculosis disease. International Journal of Tuberculosis and Lung Disease, 2013, 17:432–446.)
Summary of findings
Quality assessment
No of cases Effect
Importance
Quality
Other Screening in Relative
No of studies Design Limitations Inconsistency Indirectness Imprecision Other case detection Absolute
considerations risk group (95%CI)

1. Impact on case detection

Studies of contribution to overall case detection
4 studies1: Cross sectional Not serious Serious Not serious Not serious 1206 6246 19% of all notified bacteriological
positive cases LOW IMPORTANT
Ontario 96 1020 10% of all notified bacteriological positive
Kolin 109 319 34% of all notified bacteriological positive
Netherlands 981 4872 20% of all notified bacteriological positive
Cambodia 20 35 57% of all notified bacteriological positive
2. Impact on time to diagnosis and severity at diagnosis
No studies IMPORTANT

3. Impact on treatment outcomes

No studies CRITICAL

5. Impact on TB epidemiology
No studies CRITICAL

1Meijer (1971) reported contribution from routine CXR screening in chest clinics, including people with previous fibrotic lesions on CXR, but also contacts and recent TST converters, from Canada (Ontario), Czechoslovakia (Kolin district)
and The Netherlands in various time periods in the 1950s and 60s. Okada (2012) reported contribution of re-screening two years after a prevalence survey, of people who had been identified with active TB and people with CXR abnormalities
but no active TB, in the initial survey.
 Should systematic screening for active TB be done in communities with high TB burden?

Note: For full references to cited studies, see systematic review 1 (Kranzer K et al. A systematic literature review of the benefits to communities and
individuals of active screening for tuberculosis disease. International Journal of Tuberculosis and Lung Disease, 2013, 17:432–446.)

Summary of findings
Quality assessment
No of cases Effect
Importance
Other Through Total in same Relative Quality
No of studies Design Limitations Inconsistency Indirectness Imprecision Absolute
considerations screening population (95%CI)

1. Impact on case detection

1.1. Studies assessing proportion of detected cases through screening out of all notified cases
Cross sectional studies
10 studies Cross-sectional11 Serious 12 Serious 13 Serious 14 Not serious None NA Proportion of cases through screening: VERY LOW IMPOPRTANT
Meijer 1971a1 90 646 14% of bacteriologically positive cases
Meijer 1971b2 140 1020 14% of bacteriologically positive cases
Meijer 1971c3 229 618 37% of bacteriologically positive cases
Krivinka 1974 4 19 96 20% of bacteriologically positive cases
Meijer 1971d5 1682 4872 35% of bacteriologically positive cases
Aneja 19846 26 13 67% of all notifies cases
Santha 20037 211 508 25% of all notified cases
Harper 1996 8 71 1175 6% of all notified cases
Gonzalez 2009 9 24 19 56% of all notified cases
Garcia 2000 10 92 15 86% of all notified cases

1 Canada 1960-69. Mass miniature radiography screening in selected communities with a previous known case of TB , excluding in those <30 years who were TST negative, covering 18% of the population annually. Numbers do not include the
reported routine hospital admission screening, covering 4% of the population, which yielded additional 66 (10%) of the total cases.
2 Canada 1967-68. MMR screening in community, industries, pre-employment and “others”, reaching about 10% of the population. Numbers in the table do not include yield from other than community screening, hospital admission screening (90

cases), “routione Xray” in hospitals , private clinics and chest clinics (136 cases) prison screening (16), contact investigation (35 cases). These cvases constitute an additional 277 (27%) of all bacteriologically positive cases.
3 Czechoslovakia 1961-69. MMR community screening in Kolin district, every 2-3 years, reaching 95% of population >15 years. Screening of people with known fibrotic lung lesions (191 cases) not included here.
4 Czechoslovakia 19729. MMR community screening in Kolin district, reaching 95% of population >15 years. Screening of people with known fibrotic lung lesions (8 cases) cases) not included here.
5 Netherlands 1951-67. MMR screening in community, people >14 years, covering ¼-1/3 of population each year
6 Lay health care workers identified TB suspects in the community, prepared microscopy slides and facilitated transport to microscopy centres.
7 Door-door in approx one third of the population
8 Temporary microscopy camps were put up in remote villages
9 Home visits only to specific risk groups (elderly, heavy alcohol users, ex-prisoners, HIV positive, socio-economically vulnerable)
10 Screening in mixed risk groups on community level or institutions: jails, shelters, orphanages, alcohol support groups and other risk groups.
11 Comparing number of TB cases detected through screening with total number of TB detected through screening and passive case finding combined in the intervention area.
12 None of the studies compared screening with an alternative intervention since in settings screening was combined with passive case detection. It is unknown in all studies if cases detected through screening would have been detected through

passive case finding had screening not been done. The study design does not allow a direct assessment of effect of screening on additional case detection. Many studies are from the pre-DOTS era
13 Large variation in proportion of cases detected through screening, related to the differences across studies in type and size of target population and differences in screening method.
14 Due to inherent limitation of study design
 Summary of findings
Quality assessment
No of cases/population Effect
Importance
Quality
Other Relative
No of studies Design Limitations Inconsistency Indirectness Imprecision Intervention Control Absolute
considerations (95%CI)

1. Impact on case detection

1.2. Community randomized trials
Health extension workers informed community about TB and identified TB symptomatics and collected sputum samples at health posts once a month over 20 months. Sputum smear positive notification detection rate
1 (Datiko 2009) RCT Serious 15 Only one trial Serious 16 Not serious None 230/178138 88/118673 RR 1.5517 Case detection rate 53% higher in LOW
(129/100,000) (74/100,000) intervention clusters (95% CI; 40 to 65%) 18

Community promoters informed about TB symptoms, sputum collection in monthly outreach clinics in rural areas over 1 year. Sputum smear positive case notification rate
1 (Shargie 2006) RCT Serious 19 Only one trial Serious16 Serious8 None 159/127607 221/225284 RR 1.27 27 more cases detected per 100,000 VERY LOW
CRITICAL
(125/100,000) (98/100,000) (0.81;1.72) population
(from 19 fewer to 72 more)
Door-to-door screening for symptomatics in poor urban areas
1 (Miller 2010) RCT Not serious Only one trial Serious16 Serious 20 None N=11249 N=12304 Rate Ratio 330 more cases detected per 100,000 LOW
During 19: 934/100000 16: 604/100,000 1.55(1.10;1.99) population per year (from 60 more to 598
intervention 27d 32: 516/100000 41: 493/100,000 1.05(0.56;1.54) more) during intervention, no difference 60
Intervention +60d days after
Infants screened 3 monthly through household visits; suspected TB disease was investigated as inpatient
1 (Moyo 2012) RCT Serious 21 Only one trial Serious 22 Not serious None 89/4109 PY 36/4372 PY 2.6 (1.8-4.0) 1,317 more cases detected per 100,000 LOW
(2166/100000) (823/100,000) population per year (from 659 more to 2470
more per 100,000)
Repeat information campaigns about TB to the community, decentralised sputum collection points with easy access, sputum collection in health camps, over 3 years
1 (Ayles 2012) RCT Not serious Only one trial Serious 23 Serious None Cases at 0 vs. Cases at 0 vs. 3 years 1.0 No difference in the change in case LOW
3 years 2024/2181 (0.93) notification between intervention and
875/946 (0.92) control

15 Method of calculating the main outcome is unclear. The actual method of screening/identification of TB symptomatic is not clearly described. Randomization is described, but little baseline data is provided
16 only been assessed in one setting
17 Crude ratio of case notification rates. Not enough data to calculate CI, adjusted for clustering
18 Authors only report difference in mean case detection rate, which conventionally is the ratio of case notification to the estimated TB incidence, though it is not stated in the paper exactly how it has been calculated
19 The method for choosing which communities received the intervention is not described. Few baseline comparison data are given, but the map suggests a non-random selection and differences between intervention and control communities. The

communities were contiguous so there could be contamination.

20 Borderline significance for short term impact and no significant impact after 60 days.
21 Case definition includes main criteria for positive screen. Overdiagnosis possible
22 Only been assessed in one setting, and concerns young children only.
23 Only been assessed in one setting.
 Summary of findings
Quality assessment
Cases/population, mean or median Effect Importance
Quality
No of studies Design Limitations Inconsistency Indirectness Imprecision Other Intervention Control Relative (95%CI) Absolute
2. Impact on time to diagnosis and severity at diagnosis
2.1. Studies of delay from reported onset of symptoms to start of treatment
Studies of proportion of patients with delay more than 90 days, general community screening
1 (Shargie 2006a) Cross sectional Serious 24 Only one study Serious 25 Serious 7/13(54%) 14/24(58%) 0.93 4% less in the screening group VERY LOW
Studies of median delay, door-to-door, RCT community screening
1 (Miller 2010) RCT Serious24 Only one study Serious25 No serious 56 days 56 days No difference LOW
Studies of mean time from birth to diagnosis in cohort of newborn children MPORTANT
1 (Moyo 2012) RCT Serious 26 Only one study Serious25 No serious 13.2 months 16.6 months 3.4 months shorter in screening group (0.3 LOW
to 6.5 months shorter)
Study of proportion of patients with delay more than 90 days, RCT community screening
1 (Shargie 2006b) RCT Serious Only one study Serious25 No serious 65/159 (41%) 139/221 (63%) 0.65 (0.49- 0.81 22% less in the screening arm (12-32% less) LOW
Proportion with cough <3 weeks at time of diagnosis, community screening
1 (Santha 2003 Cross sectional Serious Only one study Serious No serious 37% 58% 2.06 19/100 more with short duration in screened VERY LOW
2.2. Studies of severity of disease at time of diagnosis
Proportion sputum smear positive in screening compared to passive case finding
7 studies Cross sectional Not serious Not serious Serious 32 Not serious 813/2128 (0.38) 2479/3865(0.64) 0.60(0.56;0.63) 40/100 lower in screening
Den Boon 2008 18/27(67%) 446/473(94%) 0.71 27/100 lower in screening
Meijer 1971a27 47/90(52%) 265/425(62%) 0.84 10/100 lower in screening
Meijer 1971b28 63/140(45%) 420/603(70%) 0.64 25/100 lower in screening
Meijer 1971c29 25/81(31%) 44/98(45%) 0.69 14/100 lower in screening VERY LOW IMPORTANT
Krivinka 1974 30 4/19(21%) 8/21(38%) 0.55 17/100 lower in screening
Meijer 1971d31 646/1682(38%) 1288/2209(58%) 0.65 20/100 lower in screening
Moyo 2012 10/89 (11%) 8/36(22%) 0.46 11/100 lower in screening
Smear grade among sputum smear positive cases, reporting percentage scanty, proportion 2+ or 3+ out of all smear positive IMPORTANT
2 studies: Cross sectional Not serious Not serious Not serious Not serious 97/229 (0.42) 665/954(0.79) 0.61(0.52;0.71) LOW
Den Boon 2008 10/18(0.56) 314/446 (0.70) 30/100 fewer smear grade 2+ or 3+ in
Shetty 87/211(0.41) 351/508(0.69) screened (122/100 to 36/100 lower)

24 Self reported onset of disease may not be reliable, and recall bias may vary between screened cases and those passively detected. No study assessed changed in delay after introduction of screening
25 Only one study
26 Most cases were diagnosed on the bases of symptoms and not on the bases of microbiology, and case definition thus included the maincriteria for positive screen. Overdiagnosis is likely.
27 Canada 1960-69. Mass miniature radiography screening in selected communities with a previous known case of TB , excluding in those <30 years who were TST negative, covering 18% of the population annually. The passive case detection group

does not include patients detected through routine hospital admission screening.
28 Canada 1967-68. MMR screening in community, industries, pre-employment and “others”, reaching about 10% of the population. The passive case detection group does not include patients detected through hospital admission screening, “routine

Xray” in hospitals , private clinics and chest clinics, prison screening, contact investigation..
29 Czechoslovakia 1961-69. MMR community screening in Kolin district, every 2-3 years, reaching 95% of population >15 years. The passive case detection group does not include patients detected through screening of people with known fibrotic lung

lesions.
30 Czechoslovakia 19729. MMR community screening in Kolin district, reaching 95% of population >15 years. The passive case detection group does not include patients detected through screening of people with known fibrotic lung lesions.
31 Netherlands 1951-67. MMR screening in community, people >14 years, covering ¼-1/3 of population each year
32 Method of diagnosis not necessarily the same in screened and non-screened groups.
 Summary of findings
Quality assessment
No of cases/population Effect
Importance
Quality
No of studies Design Limitations Inconsistency Indirectness Imprecision Other Intervention Control Relative (95%CI) Absolute

3. Impact on treatment outcomes

633 Cross-sectional Serious 34 Not serious Serious 35 Not serious Treatment success Treatment success Pooled VERY LOW
1.00(.98;1.02) Same number of successfully treated
den Boon 2008 16/20 (80%) 380/473(80%) RR=1.0 (0.83;1.2) patients among those identified
Ayles 2012 597/771(77%) 2406/3151(77%) RR=0.98 (0.95;1.01) through screening and those CRITICAL
Santha 2003 107/153(70%) 361/508(71%) RR=0.99 (0.91;1.08) identified through passive case
Cassles 1982 62/100(62%) 110/159(69%) RR=0.95 (0.83;1.08) finding
Harper 1996 50/68(74%) 997/1306(76%) RR=0.98 (0.87;1.09
Eang 2012 370/384(96%) 573/602(95%) RR=1.01 (0.99;1.04)
4. Impact on TB epidemiology
4.1. One time household screening in randomly selected clusters in high burden setting, comparing smear-positive notification rate in intervention clusters with baseline and national rate two years after screening

1 (Okada 2012) Cohort study Serious Only one study Serious Not serious 34 89.5 (404/100,000)
Standardized 250 less smear positive cases per 100,000 VERY LOW
(154/100,000) notification rate population 2 years after one-off screening
0.38 (0.27-
0.52)
4.2. 6-mothly community screening with mobile van or door-door vs. baseline pre-intervention, in a high burden setting, over 3 years, comparing TB prevalence before and after intervention
1 (Corbett 2010) Cluster Serious 36 Only one study Serious Not serious 3.7/1000 (2.6- Baseline prevalence Adj RR 0.59 280 fewer prevalent cases per 100,000 LOW
randomised 5.0) 6.5/1000 (5.1-8.3) (0.40-0.89) population after 3 years CRITICAL
trial (41 cases) (66 cases) p=0.01
Repeat information campaigns about TB to the community, decentralised sputum collection points with easy access, sputum collection in health camps, over 3 years
1 Ayles 2012 RCT No serious Only one study Serious 37 Serious 38 TB prevalence TB prevalence Adj RR TB: 216/100,000 higher prevalance in the LOW
927/100,000 711/100,000 1.11 (0.87- intervention are (from 92 less to 299 more)
1.42)

Infection Infection incidence Adj RR 3.6/1000 higher infection incidence in the

incidence 1.05% infection: 1.36 intervention arm (from 4.3/1000 less to
1.41% (0.59-3.14) 22/1000 more)

33Only including studies comparing a cohort of patients among identified through screening and a cohort of patients identified through passive case finding
34Not controlled for severity at time of diagnosis and other patient related factors
35None of the studies compared change in treatment success rate when introducing screening.
36 No control area without intervention, only two different interventions. Difficult to control for secular trend.
37 Only studies in one setting. The major part of the intervention is information campaign combined with decentralized sputum collection points
38 Not powered to detect small difference in prevalance or infection incidence
 Should systematic screening for active TB be done among homeless, in shelters, or among drugusers?

Note: For full references to cited studies, see systematic review 1 (Kranzer K et al. A systematic literature review of the benefits to communities and
individuals of active screening for tuberculosis disease. International Journal of Tuberculosis and Lung Disease, 2013, 17:432–446.)
Summary of findings
Quality assessment
No of cases/population Effect
Importance
Other Relative Quality
No of studies Design Limitations Inconsistency Indirectness Imprecision Intervention Control Absolute
considerations (95%CI)
1. Impact on case detection
1.1. Cross sectional studies assessing proportion of detected cases through screening vs. all notified cases
1.1.1. Community-based screening, including screening in specific risk populations
1 (de Vries 2007) Cross- Serious Only one study Serious Serious None 28 562 5% of all notified cases VERY LOW IMPORTANT
sectional1
2. Impact on time to diagnosis and severity at diagnosis
2.2. Studies of severity of disease at time of diagnosis
2.2.1. Proportion sputum smear positive in screening compared to passive case finding
3: Cross sectional Not Serious Not Serious Serious Not Serious 58/131(0.44) 220/337(0.65) 0.67(0.55;0.83) 21/100 fewer in screening (From 11/100
IMPORTANT
Ross 1977 31/54(0.58) 46/71(0.85) 0.68 to 35/100 fewer)
Capewell 1986 10/41(0.26) 15/26(0.58) 0.45
Story 2008 15/25(0.44) 158/240(0.66) 0.67 VERY LOW
2.2.3. Chest X-ray indicating severe disease
1 Ross 1977 Cross sectional Serious Not Serious Serious Not Serious 7/54 (0.13) 22/71(0.31) 0.51(0.24;1.10) 15/100 fewer severe in screening group
(24/100 fewer to 3/100 more)
3. Impact on treatment outcomes
No study
4. Impact on TB epidemiology
Impact on TB in the general community, incidence decline
1 (Rendelman Secular trend, Serious 2 Only one study Serious 3 Not serious 29/100,000 227/100,000 (39 0.13 34 fewer cases, or 198/100,000 pop. In the
1999) before-after (5 cases) cases) (0.05 to 0.32) intervention district 10 years after screening
1985-1995 was introduced (between 154 and
215/100,000 fewer) No downward trend in CRITICAL
other districts. VERY LOW
Impact within the risk group, incidence decline
1 (De Vries 2007) Secular trend, Serious 4 Only one study Serious 5 Not serious 11/4500 24/4500: 0.46 309/100,000 fewer incident cases after
before-after 244/100,000 553/100,000 (0.22 to 0.93) intervention. (between 34 and 431 fewer)
2002-2005

1 Comparing number of TB cases detected through screening with total number of TB detected through screening and passive case finding in the intervention area. All studies targeted specific subpopulations, none covered the whole population. The
proportion of the population covered varied but was not consistently reported in the studies.
2 No control group, only before after and compared with overall trend in the state of Oregon. No control for other possible confounding events
3 Only one study in one setting.
4 No control group, only before after with the risk group.
5
Only one study in one setting.