DRUG-RESISTANT TUBERCULOSIS CASE-FINDING STRATEGIES: A SCOPING REVIEW (Preprint)

BACKGROUND Finding individuals with drug-resistant (DR) tuberculosis (TB) is important to control the pandemic and improve patient clinical outcomes. To our knowledge systematic reviews assessing 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 assessed the available literature on DR-TB case-finding strategies using standard scoping review methodology. 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 TB symptoms, patients already diagnosed with TB or were laboratory-based. We searched the academic databases of Medline (PubMed), Embase (Ovid), The Cochrane Library, Africa-Wide Information (EBSCOhost), CINAHL (EBSCOhost), Epistemonikos and PROSPERO using no language or date restrictions. We screened titles, abstracts, and full text articles in duplicate. Data extraction and analyses were done in Excel. RESULTS We screened 3,028 titles and abstracts and 177 full-text articles. We identified six systematic reviews and 44 primary studies. Five reviews described yield of contact investigation and focused on household contacts, airline contacts, comparison between drug-susceptible 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 the following: 26 contact investigations; 11 outbreak investigations; 3 airline contact investigations; 2 epidemiological analyses; 1 public-private partnership programme; and an e-registry programme. Primary studies were all descriptive and included cross-sectional and retrospective reviews of programme 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 standardisation of terminology, design, and reporting of DR-TB case-finding studies. CLINICALTRIAL NCT05022238