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      Prevalence and risk factors of latent tuberculosis infection in Africa: a systematic review and meta-analysis protocol

      protocol
      Author(s): 1 , 1 , 2
      Publication date (Electronic):
      Journal: BMJ Open
      Publisher: BMJ Open
      Keywords: prevalence, epidemiology, latent TB, Africa

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          Abstract

          Introduction

          Latent tuberculosis infection (LTBI) remains a major public health problem and one of the major contributors to the pool of active tuberculosis cases. The true burden of LTBI in Africa is not known. Early modelling studies estimate that over 33% of the world’s population is infected with latent tuberculosis. We propose conducting a systematic review and a meta-analysis to evaluate the burden and risk factors of LTBI in Africa reported in studies from 2000 to 2017.

          Methods and analysis

          We will include cross-sectional studies, cohort studies and case-control studies estimating either tuberculin skin test (TST) or interferon-gamma release assay (IGRA) confirmed prevalence of LTBI and associated risk factors among people in African countries. A comprehensive search of relevant literature will be conducted on electronic databases using common and medical subject heading (MeSH) terms for LTBI, and an African search filter. Risk of bias will be evaluated by assessing all qualifying full-text articles for quality and eligibility using a quality score assessment tool. Standardised data extraction will be carried out after which prevalence estimates will be pooled using random-effects models in Stata V.13. Where there is sufficient data , subgroup meta-analyses will be conducted by risk factors including participant’s age group, occupation, location and HIV status. This systematic review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols 2015 Statement.

          Ethics and dissemination

          No ethical issues were foreseen given that this was a protocol for a systematic review of published studies. The results of this study will be published in a peer-reviewed journal and presented at conferences.

          Trial registration number

          Systematic review registration: PROSPERO CRD42016037997

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          Most cited references17

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          LTBI: latent tuberculosis infection or lasting immune responses to M. tuberculosis? A TBNET consensus statement.

          G Bothamley, L N V S Arend, P Ravn … (2009)
          Tuberculosis control relies on the identification and preventive treatment of individuals who are latently infected with Mycobacterium tuberculosis. However, direct identification of latent tuberculosis infection is not possible. The diagnostic tests used to identify individuals latently infected with M. tuberculosis, the in vivo tuberculin skin test and the ex vivo interferon-gamma release assays (IGRAs), are designed to identify an adaptive immune response against, but not necessarily a latent infection with, M. tuberculosis. The proportion of individuals who truly remain infected with M. tuberculosis after tuberculin skin test or IGRA conversion is unknown. It is also uncertain how long adaptive immune responses towards mycobacterial antigens persist in the absence of live mycobacteria. Clinical management and public healthcare policies for preventive chemotherapy against tuberculosis could be improved, if we were to gain a better understanding on M. tuberculosis latency and reactivation. This statement by the TBNET summarises knowledge and limitations of the currently available tests used in adults and children for the diagnosis of latent tuberculosis infection. In summary, the main issue regarding testing is to restrict it to those who are known to be at higher risk of developing tuberculosis and who are willing to accept preventive chemotherapy.
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            Beyond the IFN-γ horizon: biomarkers for immunodiagnosis of infection with Mycobacterium tuberculosis.

            Novel N Chegou, Jan Heyckendorf, Morten Ruhwald … (2014)
            Latent infection with Mycobacterium tuberculosis (LTBI) is defined by the presence of M. tuberculosis-specific immunity in the absence of active tuberculosis. LTBI is detected using interferon-γ release assays (IGRAs) or the tuberculin-skin-test (TST). In clinical practice, IGRAs and the TSTs have failed to distinguish between active tuberculosis and LTBI and their predictive value to identify individuals at risk for the future development of tuberculosis is limited. There is an urgent need to identify biomarkers that improve the clinical performance of current immunodiagnostic methods for tuberculosis prevention, diagnosis and treatment monitoring. Here, we review the landscape of potential alternative biomarkers useful for detection of infection with M. tuberculosis. We describe what individual markers add in terms of specificity for active/latent infection, prediction of progression to active tuberculosis and immunodiagnostic potential in high-risk groups' such as HIV-infected individuals and children.
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              Developing a geographic search filter to identify randomised controlled trials in Africa: finding the optimal balance between sensitivity and precision.

              Elizabeth Pienaar, Liesl Grobler, Karishma Busgeeth … (2011)
              Research on identifying trials using geographic filters is limited. To test the sensitivity and precision of a filter to identify African randomised controlled trials (RCTs). We searched medline and embase for RCTs published in 2004 using a Cochrane filter for RCTs. The search was limited to HIV/AIDS but irrespective of location. Two investigators independently identified African RCTs from the retrieved records forming a reference set. We then repeated the search using an African geographic filter comprising country and regional terms forming the filter set. We compared the sensitivity and precision of the sets. The medline reference set comprised 1799 records with 23 African RCTs; for embase, the reference set comprised 763 records with 37 African RCTs. The medline filter set comprised 180 records with 17 African RCTs; the embase filter set comprised 98 records with 27 African RCTs. Sensitivity of the filter was 74% (medline) and 73% (embase). Addition of the filter improved precision from 1.3% to 9.4% (medline) and from 5% to 28% (embase). The African filter improved precision with some loss in sensitivity. Incomplete reporting of trial location in electronic bibliographic records restricts efficiency of geographic filters. Prospective trial registration should alleviate this. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.
              Article 0 comments Cited 46 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Open (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2017
                Publication date (Electronic): 18 July 2017
                Volume: 7
                Issue: 7
                Electronic Location Identifier: e012636
                Affiliations
                [1 ] departmentDepartment of Epidemiology & Biostatistics, School of Public Health , Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, South Africa
                [2 ] departmentDepartment of Medicine , Faculty of Health Sciences University of Cape Town and Groote Schuur Hospital , Cape Town, South Africa
                Author notes
                [Correspondence to ] Jabulani Ncayiyana; jabulani.ncayiyana@ 123456wits.ac.za
                Article
                Publisher ID: bmjopen-2016-012636
                DOI: 10.1136/bmjopen-2016-012636
                PMC ID: 5541490
                PubMed ID: 28720611
                SO-VID: a0a900a3-e3f9-4230-9212-d8460ee9efbc
                Copyright © © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 13 May 2016
                Date revision received : 24 August 2016
                Date accepted : 03 January 2017
                Categories
                Subject: Epidemiology
                Subject: Protocol
                Subject: 1506
                Subject: 1692
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: prevalence,epidemiology,latent tb,africa
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: prevalence, epidemiology, latent tb, africa

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