Table 1 Study Characteristics

Abimbola et al. 2012

South Africa

PLHIV initiating ART

1) WHO 4SS; SSM; SM (−) followed by CXR; CXR (−) followed by culture

2) WHO 4SS; Xpert for diagnosis

Standard practice: SSM; SM (−) followed by CXR

Health system

Adelman et al. 2017

Ethiopia

PLHIV in HIV clinics

WHO 4SS; Xpert for diagnostic test of PLHIV with positive symptom screen (i.e. at least 1 symptom); Xpert( +) then DST/culture

Current recommended practice: 4SS, the SM and/or clinical diagnosis of TB

Health system

Andrews et al. 2012

South Africa

ARV naïve, PLHIV

Initial WHO 4SS then:

1) SSM (2 samples)—Xpert in TB-symptomatic;

2) SSM (2)—Xpert in all;

3) Culture (2)—Xpert in TB-symptomatic;

4) Culture (2)—Xpert in all;

5) Xpert (1) in TB-symptomatic;

6) Xpert (1) in all;

7) Xpert (2) in TB-symptomatic;

8) Xpert (2) in all

No TB screening

Health system

Bassett et al. 2010

South Africa

PLHIV initiating ART

ICF: WHO 4SS and CXR, then all PLHIV provided sputum for QIAmp (PCR) and culture

Symptoms (cough > 2 weeks)

Health system

Bogdanova et al. 2019

Russian Federation

General population, PLHIV, homeless, migrants, chronic medical conditions

1) Contact tracing done then CXR and SSM for diagnosis; 2) Mass screening in hospitals using CXR and SSM; 3) Mass screening in TB dispensary using mobile CXR then SSM

PCF including CXR and SSM

Health system

James et al. 2017

Cambodia

poor, urban residents; elderly living in rural areas

ACF interventions: 1) HOPE—Door-to-door screening WHO 4SS, symptomatic patients SSM (LED), then Xpert and culture; 2) CATA—Door-to-door screening older patients WHO 4SS, if symptomatic referred for CXR screening, if abnormal then Xpert

N/A

Health system

Ji et al. 2020

China

Diabetic patients

ACF intervention—Patients received regular physical exams for 3 years; Diabetes patients all WHO 4SS, then positive symptom had CXR, then SSM, SM(-) then culture for TB confirmation

N/A

Health system

Jit et al. 2011

United Kingdom

Hard to reach individuals

Find and Treat service: 48 mobile CXR screening units offering: 1) mobile CXR; 2) enhanced case management; 3) referral for loss-to-follow-up

PCF – people passively presenting to hospital

Health system

Jo et al. 2020

Cambodia, Tajikistan

Cambodia—elderly, vulnerable groups in rural areas

Tajikistan—detention centers and diabetic patients

Cambodia—Community sensitization and training of CHWs, door-to-door WHO 4SS by CHWS, all patients had mobile CXR, abnormal CXR then Xpert

Tajikistan—Community sensitization and training of TB staff, CHWs used mobile-phone questionnaire at health facilities WHO 4SS followed by CXR, SSM then Xpert based on SSM results

N/A

Health system

Karki et al. 2017

Papua New Guinea

General population in rural villages

Outreach visits to villages: Systematic 4SS throughout villages, if symptomatic then SSM

N/A

Health system

Kranzer et al. 2012

South Africa

Peri-urban population attending mobile testing

Mobile HIV testing van added TB testing: WHO 4SS for all HIV(-), if symptomatic then SSM; all HIV + SSM and referral to TB clinic for evaluation including CXR

N/A

Health system

Machekera et al. 2019

Zimbabwe

High-risk groups: PLHIV, contacts, miners, HCW, prisoners, elderly

Zimbabwe ACF: WHO 4SS, then all have CXR, if either 4SS or CXR positive then Xpert with clinical diagnosis, if needed

WHO algorithms:

WHO2b: 4SS, if positive then Xpert and clinical diagnosis, if needed

WHO2d: 4SS, if positive then CXR, then Xpert then clinical diagnosis

WHO3b: CXR, then Xpert and clinical diagnosis, if needed

Health system

Maheswaran et al. 2012

Sub-Saharan Africa

PLHIV

1) Any classic symptom; 2) 2 + classic symptoms; 3) CXR on all; 4) SSM on all; 5) 4SS, if positive then CXR; 6) 4SS, if positive then SSM; 7) 4SS, if positive then SSM then CXR; 8) 4SS if positive then CXR then SSM

Chronic cough > 2 weeks

Health system

Murray et al. 2016

Uganda

General population

WHO 4SS, if cough > 2 weeks then triage testing with CXR or CRP then Xpert for diagnosis

PCF (baseline scenario): WHO 4SS, no triage testing, if symptomatic then Xpert

Health system

Orlando et al. 2018

Mozambique

PLHIV

1) Xpert: Xpert for all participants; 2) LAM: urine TB-LAM in all patients with CD4 < 200; Xpert in all patients with CD4 > 200 and TB-LAM(-) with CD4 < 200

Standard: WHO 4SS, if symptomatic then SSM

Health system

Reddy et al. 2019

Malawi, South Africa

Hospitalized PLHIV

ICF intervention: Sputum Xpert, urine LAM and urine Xpert

Modified intervention: Sputum Xpert and TB-LAM

Standard of care: Xpert

Health system

Sekandi et al. 2015

Uganda

HHC, urban population

1) PCF + ACF: HCW perform door-to-door chronic cough surveys (> 2 weeks) then collect 2 sputum for SSM, then return test results to the patient at their home; 2) PCF + HHC investigations (HCI): HCW perform WHO 4SS to HHC in home; child contacts and those unable to produce sputum diagnosed using CXR

PCF: Self-referral or presenting to health facility, chronic cough (> 2 weeks). WHO 4SS then SSM, if unable to produce sputum then diagnosed using CXR

Health system, societal perspective

Shah et al. 2017

Peru

HHC (low HIV incidence setting)

1) ACF: PCF + HCW visits to screen HHC using WHO 4SS and SSM; 2) PCF + Xpert; 3) ACF + Xpert: HCW visits to screen HHC using WHO 4SS and Xpert for diagnosis

PCF: Self-referral or presenting to health facility, TB diagnosis using SSM and clinical evaluation

Health system

Shah et al. 2009

Ethiopia

PLHIV (18 + years) in VCT clinic

1) WHO 4SS then SSM, if SM(-) then CXR;

2) CXR for all PLHIV at entry, if CXR( +) then SSM

N/A

Health system

Shah et al. 2008

Vietnam

PLHIV

All PLHIV screened using CXR (all diagnosed HIV + before CXR), confirmed diagnosis with SSM

N/A

Health system

Smit et al. 2017

Belgium

High risk groups and contacts (asylum seekers and migrants)

Systematic screening in high-risk groups including WHO 4SS and CXR; Follow-up of asylum seekers with abnormal CXR, supplemental CXR and periodic screening (6/12 months) after arrival

N/A

Health system

Sohn et al. 2019

India

Rural, tribal population

CHW visits to homes with TB education, screening: WHO 4SS and SSM, CHW return with results

N/A

Health system

Winestsky et al. 2012

Russian Federation

Prisoners

1) CXR screening; 2) WHO 4SS; 3) Annual Xpert screening; 4) WHO 4SS + CXR; 5) CXR + Xpert; 6) WHO 4SS + Xpert; 7) WHO 4SS + CXR + Xpert

DST used for treatment planning

PCF: No screening (self-referral)

Health system

Yoon et al. 2019

Uganda

PLHIV in two HIV clinics

Novel ICF algorithms: 1) WHO 4SS + TB-LAM + Xpert;

2) WHO 4SS + TB-LAM + Xpert + culture; 3) POC CRP + Xpert; 4) POC CRP + TB-LAM + Xpert; 5) POC CRP + TB-LAM + Xpert + culture

Current ICF: WHO 4SS, if symptomatic then Xpert for diagnosis

Health system

Zhang et al. 2016

China

High risk groups including elderly (65 +)

1) WHO A1: WHO 4SS, if cough > 2 weeks then CXR, if CXR( +) then SSM; 2) WHO A1B: WHO 4SS, if cough > 2 weeks then CXR, if CXR( +) then SSM; 3) WHO A2: WHO 4SS, if any TB symptoms then CXR, if CXR( +) then SSM; 4) WHO A3: Screening with CXR, if CXR( +) then SSM

N/A

Health system

Zishiri et al. 2014

South Africa

Correctional facility inmates

WHO 4SS questionnaire for all newly admitted inmates, 1 + symptoms then diagnosed with Xpert

N/A

Health system

Zwerling et al. 2015

Malawi

Newly diagnosed PLHIV in rural Malawi

Initial WHO 4SS, if 1 or more TB symptoms, then LED or Xpert; If initial 4SS negative, then patient asked to return 1 month later for second test if still symptomatic; Diagnosis with SSM, LED and Xpert

Standard of care (i.e. discretion of treating physician) using SSM

Health system