Factors associated with tuberculosis treatment initiation among bacteriologically negative individuals evaluated for tuberculosis: an individual patient data meta-analysis.

Autor:	Kim S; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Can MH; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Agizew TB; U.S. Centers for Disease Control and Prevention, Botswana., Auld AF; U.S. Centers for Disease Control and Prevention, Lusaka, Zambia., Balcells ME; Infectious Disease Department, School of Medicine, Pontificia Universidad Católica de Chile., Bjerrum S; Department of Clinical Research, University of Southern Denmark, Odense Denmark.; Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Dheda K; Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, Cape Town, South Africa.; South African MRC Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa.; Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK., Dorman SE; Medical University of South Carolina, Charleston, SC, USA., Esmail A; Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, Cape Town, South Africa.; South African MRC Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa., Fielding K; TB Centre, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK., Garcia-Basteiro AL; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain., Hanrahan CF; Epidemiology Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Kebede W; School of Medical Laboratory Sciences, Jimma University, Jimma Ethiopia.; Mycobacteriology Research Center of Jimma University, Ethiopia., Kohli M; FIND, Geneva, Switzerland., Luetkemeyer AF; University of California San Francisco, San Francisco, CA, USA., Mita C; Countway Library of Medicine, Harvard University, Boston, MA, USA., Reeve BWP; DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa., Silva DR; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Sweeney S; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK., Theron G; DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa., Trajman A; Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.; McGill University, Montreal, QC, Canada., Vassall A; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK., Warren JL; Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA., Yotebieng M; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, New York City, NY, USA., Cohen T; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA., Menzies NA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Jazyk:	angličtina
Zdroj:	MedRxiv : the preprint server for health sciences [medRxiv] 2024 Apr 08. Date of Electronic Publication: 2024 Apr 08.
DOI:	10.1101/2024.04.07.24305445
Abstrakt:	Background: Globally, over one-third of pulmonary tuberculosis (TB) disease diagnoses are made based on clinical criteria after a negative diagnostic test result. Understanding factors associated with clinicians' decisions to initiate treatment for individuals with negative test results is critical for predicting the potential impact of new diagnostics. Methods: We performed a systematic review and individual patient data meta-analysis using studies conducted between January/2010 and December/2022 (PROSPERO: CRD42022287613). We included trials or cohort studies that enrolled individuals evaluated for TB in routine settings. In these studies participants were evaluated based on clinical examination and routinely-used diagnostics, and were followed for ≥1 week after the initial test result. We used hierarchical Bayesian logistic regression to identify factors associated with treatment initiation following a negative result on an initial bacteriological test (e.g., sputum smear microscopy, Xpert MTB/RIF). Findings: Multiple factors were positively associated with treatment initiation: male sex [adjusted Odds Ratio (aOR) 1.61 (1.31-1.95)], history of prior TB [aOR 1.36 (1.06-1.73)], reported cough [aOR 4.62 (3.42-6.27)], reported night sweats [aOR 1.50 (1.21-1.90)], and having HIV infection but not on ART [aOR 1.68 (1.23-2.32)]. Treatment initiation was substantially less likely for individuals testing negative with Xpert [aOR 0.77 (0.62-0.96)] compared to smear microscopy and declined in more recent years. Interpretation: Multiple factors influenced decisions to initiate TB treatment despite negative test results. Clinicians were substantially less likely to treat in the absence of a positive test result when using more sensitive, PCR-based diagnostics.
Databáze:	MEDLINE
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