Feasey Helena R A, Burke Rachael M, Nliwasa Marriott, Chaisson Lelia H, Golub Jonathan E, Naufal Fahd, Shapiro Adrienne E, Ruperez Maria, Telisinghe Lily, Ayles Helen, Miller Cecily, Burchett Helen E D, MacPherson Peter, Corbett Elizabeth L
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
TB Centre, London School of Hygiene and Tropical Medicine, London, London.
PLOS Glob Public Health. 2021 Dec 8;1(12):e0000088. doi: 10.1371/journal.pgph.0000088. eCollection 2021.
Community-based active case-finding (ACF) may have important impacts on routine TB case-detection and subsequent patient-initiated diagnosis pathways, contributing "indirectly" to infectious diseases prevention and care. We investigated the impact of ACF beyond directly diagnosed patients for TB, using routine case-notification rate (CNR) ratios as a measure of indirect effect. We systematically searched for publications 01-Jan-1980 to 13-Apr-2020 reporting on community-based ACF interventions compared to a comparison group, together with review of linked manuscripts reporting knowledge, attitudes, and practices (KAP) outcomes or qualitative data on TB testing behaviour. We calculated CNR ratios of routine case-notifications (i.e. excluding cases identified directly through ACF) and compared proxy behavioural outcomes for both ACF and comparator communities. Full text manuscripts from 988 of 23,883 abstracts were screened for inclusion; 36 were eligible. Of these, 12 reported routine notification rates separately from ACF intervention-attributed rates, and one reported any proxy behavioural outcomes. Two further studies were identified from screening 1121 abstracts for linked KAP/qualitative manuscripts. 8/12 case-notification studies were considered at critical or serious risk of bias. 8/11 non-randomised studies reported bacteriologically-confirmed CNR ratios between 0.47 (95% CI:0.41-0.53) and 0.96 (95% CI:0.94-0.97), with 7/11 reporting all-form CNR ratios between 0.96 (95% CI:0.88-1.05) and 1.09 (95% CI:1.02-1.16). One high-quality randomised-controlled trial reported a ratio of 1.14 (95% CI 0.91-1.43). KAP/qualitative manuscripts provided insufficient evidence to establish the impact of ACF on subsequent TB testing behaviour. ACF interventions with routine CNR ratios >1 suggest an indirect effect on wider TB case-detection, potentially due to impact on subsequent TB testing behaviour through follow-up after a negative ACF test or increased TB knowledge. However, data on this type of impact are rarely collected. Evaluation of routine case-notification, testing and proxy behavioural outcomes in intervention and comparator communities should be included as standard methodology in future ACF campaign study designs.
基于社区的主动病例发现（ACF）可能会对常规结核病病例发现及随后患者主动发起的诊断途径产生重要影响，从而对传染病预防和护理“间接地”做出贡献。我们使用常规病例报告率（CNR）比值作为间接效应的衡量指标，研究了ACF对结核病患者的影响，这些患者并非直接通过ACF确诊。我们系统检索了1980年1月1日至2020年4月13日期间发表的文献，这些文献报告了基于社区的ACF干预措施，并与对照组进行了比较，同时还回顾了相关手稿中报告的知识、态度和行为（KAP）结果或关于结核病检测行为的定性数据。我们计算了常规病例报告（即不包括直接通过ACF识别的病例）的CNR比值，并比较了ACF社区和对照社区的替代行为结果。从23,883篇摘要中筛选出988篇全文手稿以纳入研究；36篇符合条件。其中，12篇分别报告了常规报告率和ACF干预归因率，1篇报告了任何替代行为结果。通过筛选1121篇关于相关KAP/定性手稿的摘要，又确定了另外两项研究。12项病例报告研究中有8项被认为存在严重或关键的偏倚风险。11项非随机研究中有8项报告了细菌学确诊的CNR比值在0.47（95%CI：0.41 - 0.53）至0.96（95%CI：0.94 - 0.97）之间，11项中有7项报告了所有形式的CNR比值在0.96（95%CI：0.88 - 1.05）至1.09（95%CI：1.02 - 1.16）之间。一项高质量的随机对照试验报告的比值为1.14（95%CI 0.91 - 1.43）。KAP/定性手稿提供的证据不足以确定ACF对后续结核病检测行为的影响。常规CNR比值>1的ACF干预措施表明对更广泛的结核病病例发现有间接影响，这可能是由于ACF检测结果为阴性后的随访或结核病知识增加对后续结核病检测行为产生了影响。然而，关于这种影响的数据很少被收集。在未来ACF活动研究设计中，应将对干预社区和对照社区的常规病例报告、检测及替代行为结果的评估作为标准方法纳入。
