Abstract
Introduction
Most cases of Tuberculosis (TB) in low incidence countries arise in high-risk groups, such as migrants, or social risk groups. Increasingly, active case finding (ACF) initiatives amongst these groups are promoted in these settings. The aim of the review was to summarise the evidence for ACF interventions in low incidence countries.
Methods
We conducted a search on Medline (1966-2012), using a defined search strategy, to find ACF papers amongst social risk groups and migrants in low incidence countries and hand-searched reference lists of included papers and reviews.
Results
We included 27 of 578 papers for social risk groups, and 7 of 198 papers not included in a recent systematic review (Klinkenberg, 2008).
For social risk groups, the majority of studies (17 of 27) reported ACF in homeless persons, with a median of 726 (range 120-22,000) screenees, a median of 9.5 (range 0-313) detected cases and a yield of 0-6.0%. Other ACF settings included prisons (9 studies, median 11,576 screenees, yield 0.01-2.7%) and the drug user population (n=2). Among migrant studies, the overall median yield was 0.34% (a similar level to the 0.35% in the 2008 systematic review and 0.31% in the newer studies). Pre-entry screening had a significantly higher yield (1.21%).
Discussion
Despite the lack of randomised controlled trials, our review of observational studies demonstrated effectiveness of highly targeted interventions in high-risk groups. Further research to determine the best strategies for ACF in low incidence countries, and on the cost effectiveness of ACF, is needed.
- © 2013 ERS