Drug-Resistant Tuberculosis Case-Finding Strategies: Scoping Review

Background: Finding individuals with drug-resistant tuberculosis (DR-TB) is important to control the pandemic and improvepatient clinical outcomes. To our knowledge, systematic reviews assessing the effectiveness, cost-effectiveness, acceptability,and feasibility of different DR-TB case-finding strategies to inform research, policy, and practice, have not been conducted andthe scope of primary research is unknown. Objective: We therefore assessed the available literature on DR-TB case-finding strategies. Methods: We looked at systematic reviews, trials, qualitative studies, diagnostic test accuracy studies, and other primary researchthat sought to improve DR-TB case detection specifically. We excluded studies that included patients seeking care for tuberculosis(TB) symptoms, patients already diagnosed with TB, or were laboratory-based. We searched the academic databases of MEDLINE,Embase, The Cochrane Library, Africa-Wide Information, CINAHL (Cumulated Index to Nursing and Allied Health Literature),Epistemonikos, and PROSPERO (The International Prospective Register of Systematic Reviews) using no language or daterestrictions. We screened titles, abstracts, and full-text articles in duplicate. Data extraction and analyses were carried out in Excel(Microsoft Corp).Results: We screened 3646 titles and abstracts and 236 full-text articles. We identified 6 systematic reviews and 61 primarystudies. Five reviews described the yield of contact investigation and focused on household contacts, airline contacts, comparisonbetween drug-susceptible tuberculosis and DR-TB contacts, and concordance of DR-TB profiles between index cases and contacts.One review compared universal versus selective drug resistance testing. Primary studies described (1) 34 contact investigations,(2) 17 outbreak investigations, (3) 3 airline contact investigations, (4) 5 epidemiological analyses, (5) 1 public-private partnershipprogram, and (6) an e-registry program. Primary studies were all descriptive and included cross-sectional and retrospective reviews of program data. No trials were identified. Data extraction from contact investigations was difficult due to incomplete reportingof relevant information.Conclusions: Existing descriptive reviews can be updated, but there is a dearth of knowledge on the effectiveness,cost-effectiveness, acceptability, and feasibility of DR-TB case-finding strategies to inform policy and practice. There is also aneed for standardization of terminology, design, and reporting of DR-TB case-finding studies.