JMIR Publications

ABSTRACT

Background:

Transmission of drug-resistant tuberculosis (DR-TB) is ongoing. Finding individuals with DR-TB and initiating treatment as early as possible is important to improve patient clinical outcomes and to break the chain of transmission to control the pandemic. 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 it is unknown whether enough research exists to conduct such reviews. It is unknown whether case-finding strategies are similar for DR-TB and drug-susceptible TB and whether we can draw on findings from drug-susceptible reviews to inform decisions on DR-TB case-finding strategies.

Objective:

To describe the available literature on DR-TB case finding and to describe DR-TB case-finding strategies.

Methods:

We will look at systematic reviews, trials, qualitative studies, diagnostic test accuracy studies and other primary research that had sought to improve drug-resistant TB case detection specifically. We will exclude studies which invited patients seeking care for TB symptoms, patients already diagnosed with TB or were laboratory-based. We will search the academic databases of Medline, Embase, The Cochrane Library, Africa-Wide Information, CINAHL, Epistemonikos and PROSPERO using no language or date restrictions. We will screen titles, abstracts, and full text articles in duplicate. Data extraction and analyses will be done in Excel.

Results:

We will provide a narrative report with supporting figures and/or tables to summarize the data. A systems-based logic model, developed from a synthesis of drug-susceptible TB case-finding strategies, will be used as a framework to describe different strategies, resulting pathways and enhancements of pathways. The search will be conducted at the end of 2021. Title and abstract screening, full text screening and data extraction will be done from January to June 2022. Thereafter analysis will be conducted, and results written up.

Conclusions:

This scoping review will chart existing literature on DR-TB case finding. By charting the literature, we will be able to identify if primary studies on effectiveness, cost-effectiveness, acceptability, and feasibility of different DR-TB case-finding strategies exist. This will assist us in formulating potential questions for a systematic review. We will also describe DR-TB case-finding strategies and how they fit into a model of drug-susceptible TB case-finding pathways. The review has some limitations. One limitation is the diverse and inconsistent use of intervention terminology within the literature, which may result in missing relevant studies. Poor reporting of intervention strategies may also cause misunderstanding and misclassification of interventions. Lastly, drug-resistant TB case-finding strategies may not fit into a model developed from drug-susceptible strategies. Nevertheless, such a situation will provide an opportunity to refine the model for future research. The review will guide further research to inform decisions on DR-TB case finding policy and practice.