Yield of community-based TB targeted testing and treatment in foreign-born populations in the United States: A systematic review
Abstract
Objective
To synthesize outputs and
outcomes of community-based tuberculosis targeted testing and
treatment (TTT) programs in foreign-born populations (FBP) in
the United States (US).
Methods
We systematically searched
five bibliographic databases and other key resources. Two
reviewers independently applied eligibility criteria to screen
citations and extracted data from included studies. We excluded
studies that contained <50% FBP participants or that examined
steps only after diagnosis of latent TB infection (LTBI). We
stratified studies as majority FBP (50–90%) and
predominantly FBP (>90%). We used random-effects
meta-analytic models to calculate pooled proportions and 95%
confidence intervals (CI) for community-based TTT cascade steps
(e.g., recruited, tested and treated), and used them to create
two hypothetical cascades for 100 individuals.
Results
Fifteen studies conducted in
10 US states met inclusion criteria. Studies were heterogeneous
in recruitment strategies and mostly recruited participants born
in Latin America. Of 100 hypothetical participants
(predominantly FBP) reached by community-based TTT, 40.4 (95% CI
28.6 to 50.1) would have valid test results, 15.7 (95% CI 9.9 to
21.8) would test positive, and 3.6 (95% CI 1.4 to 6.0) would
complete LTBI treatment. Likewise, of 100 hypothetical
participants (majority FBP) reached, 77.9 (95% CI 54.0 to 92.1)
would have valid test results, 26.5 (95% CI 18.0 to 33.5) would
test positive, and 5.4 (95% CI 2.1 to 9.0) would complete LTBI
treatment. Of those with valid test results, pooled proportions
of LTBI test positive for predominantly FBP and majority FBP
were 38.9% (95% CI 28.6 to 49.8) and 34.3% (95% CI 29.3 to
39.5), respectively.
Conclusions
We observed high
attrition throughout the care cascade in FBP participating in
LTBI community-based TTT studies. Few studies included cascade
steps prior to LTBI diagnosis, limiting our review findings.
Moreover, Asia-born populations in the US are substantially
underrepresented in the FBP community-based TTT literature.
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Source:
PLOS ONE
