False negatives, who are screen-negative but have active TB. There is also potential community benefit of this outcome, through reduced TB transmission [10]. 2005, Cambodia: National Tuberculosis Control Program, Ministy of Health Department of Health Government of Myanmar: Report on National TB Prevalence Survey 2009-2010.
Edited by: Schaaf HS, Zumla AI.

Steingart KR, Sohn H, Schiller I, Kloda LA, Boehme CC, Pai M, Boehme CC, Dendukuri N: Xpert(R) MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults (updated). Lancet. The sensitivity of the confirmatory test are based on clinical studies [30, 31], and is generally lower in early case detection, like in prevalence surveys [6, 26, 32].

To inform the choice of an appropriate screening and diagnostic algorithm for tuberculosis (TB) screening initiatives in different epidemiological settings, we compare algorithms composed of currently available methods. Instead an estimation of the specificity of the screen, the NNS and PPV could be obtained from routine monitoring data on participation in the screening program, the numbers and proportions of persons testing positive on screening and of TB cases diagnosed, and by periodic retesting of the persons diagnosed with TB with a more sensitive method (culture). By using this website, you agree to our At up to 2% prevalence of TB in the screened population, the positive predictive value for all algorithms is less than 75% when sputum-smear microscopy is used as the initial diagnostic test and where clinical diagnosis is considered for those who test negative by sputum-smear microscopy. statement and Detailed information on the outcomes of the screening and confirmatory testing is available in the Additional file 1: Table S1. In clinical settings where mycobacterial cultures are not part of the routine diagnostic work-up, all or most patients who report with suggestive symptoms but have negative smears are expected to be evaluated clinically. Lancet Infect Dis. The current global rate of decline in TB incidence, at about 2% annually, is grossly insufficient to reach the goal of TB elimination by 2050 [1]. CXR as a second screen for symptom screen positives improves efficiency. CAS  Maduskar P, Muyoyeta M, Ayles H, Hogeweg L, Peters-Bax L, van Ginneken B: Detection of tuberculosis using digital chest radiography: automated reading vs. interpretation by clinical officers. However resource requirements for tests and equipment may be prohibitive in some settings and a reason to opt for symptom screening and SSM. In panel A one screening tool is applied (e.g.

Of algorithms using screening for prolonged cough the NNS is 3-4 times higher compared to the NNS of the most sensitive algorithm and exceeds 1000 if the TB prevalence is below 0.5%.

This is more efficient compared to any CXR abnormality (29 XP tests), due to better specificity. This analysis concerns screening scenarios, but has relevance for diagnostic algorithms among people actively seeking care with TB symptoms as well.

We compare the yield, positive predictive value, and requirements in terms of diagnostic tests. PLoS One. Furthermore (ii) the positive predictive value (PPV), i.e. The PPV of screening for any symptom followed by SSM does not reach 50% even if the TB prevalence is 2%. As the sensitivity analysis points out, considerable variation in the NNS can be expected from variation in the sensitivity of the screening and confirmatory tests. Although this combination is the standard screening in TB prevalence surveys, it has little advantage for an active screening program as the sensitivity of symptom and CXR screening in parallel is only marginally better compared to the sensitivity of CXR screening for any abnormality alone, and its specificity is worse [5].

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