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Lancet Infect Dis. 2019 Mar;19(3):e89-e95. doi: 10.1016/S1473-3099(18)30443-2. Epub 2018 Dec 13.

Spatially targeted screening to reduce tuberculosis transmission in high-incidence settings.

Author information

1
Section of Infectious Disease, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA. Electronic address: patrick.cudahy@yale.edu.
2
Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.
3
Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Cambridge, MA, USA.
4
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
5
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
6
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
7
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.
8
Department of Epidemiology (Microbial Diseases), Yale University School of Public Health, New Haven, CT, USA.

Abstract

As the leading infectious cause of death worldwide and the primary proximal cause of death in individuals living with HIV, tuberculosis remains a global concern. Existing tuberculosis control strategies that rely on passive case-finding appear insufficient to achieve targets for reductions in tuberculosis incidence and mortality. Active case-finding strategies aim to detect infectious individuals earlier in their infectious period to reduce onward transmission and improve treatment outcomes. Empirical studies of active case-finding have produced mixed results and determining how to direct active screening to those most at risk remains a topic of intense research. Our systematic review of literature evaluating the effects of geographically targeted tuberculosis screening interventions found three studies in low tuberculosis incidence settings, but none conducted in high tuberculosis incidence countries. We discuss open questions related to the use of spatially targeted approaches for active screening in countries where tuberculosis incidence is highest.

PMID:
30554997
PMCID:
PMC6401264
[Available on 2020-03-01]
DOI:
10.1016/S1473-3099(18)30443-2

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