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

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dc.article.number1004502
dc.catalogadoraba
dc.contributor.authorKim, Sun
dc.contributor.authorCan, Melike Hazal
dc.contributor.authorAgizew, Tefera B.
dc.contributor.authorAuld, Andrew F.
dc.contributor.authorBalcells Marty, María Elvira
dc.contributor.authorBjerrum, Stephanie
dc.contributor.authorDheda, Keertan
dc.contributor.authorDorman, Susan E.
dc.contributor.authorEsmail, Aliasgar
dc.contributor.authorFielding, Katherine
dc.contributor.authorGarcia-Basteiro, Alberto L.
dc.contributor.authorHanrahan, Colleen F.
dc.contributor.authorKebede, Wakjira
dc.contributor.authorKohli, Mikashmi
dc.contributor.authorLuetkemeyer, Anne F.
dc.contributor.authorMita, Carol
dc.contributor.authorReeve, Byron W. P.
dc.contributor.authorSilva, Denise Rossato
dc.contributor.authorSweeney, Sedona
dc.contributor.authorTheron, Grant
dc.contributor.authorTrajman, Anete
dc.contributor.authorVassall, Anna
dc.contributor.authorWarren, Joshua L.
dc.contributor.authorYotebieng, Marcel
dc.contributor.authorCohen, Ted
dc.contributor.authorMenzies, Nicolas A.
dc.date.accessioned2025-03-31T16:13:19Z
dc.date.available2025-03-31T16:13:19Z
dc.date.issued2025
dc.description.abstractBackground Globally, over one-third of pulmonary tuberculosis (TB) disease diagnoses are made based on clinical criteria after a negative bacteriological test result. There is limited information on the factors that determine clinicians' decisions to initiate TB treatment when initial bacteriological test results are negative.Methods and findings 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 (SSM), Xpert MTB/RIF). 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. We were not able assess why clinicians made treatment decisions, as these data were not available.Methods and findings 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 (SSM), Xpert MTB/RIF). 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. We were not able assess why clinicians made treatment decisions, as these data were not available.Conclusions 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.
dc.description.funderNational Institute of Allergy And Infectious Diseases of the National Institutes of Health; Folio: U01AI152084 to SD
dc.format.extent18 páginas
dc.fuente.origenORCID
dc.identifier.doi10.1371/journal.pmed.1004502
dc.identifier.eissn1549-1676
dc.identifier.issn1549-1277
dc.identifier.scopusid2-s2.0-85214931799
dc.identifier.urihttps://doi.org/10.1371/journal.pmed.1004502
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/103028
dc.identifier.wosidWOS:001395693700001
dc.information.autorucEscuela de Medicina; Balcells Marty, María Elvira; 0000-0002-7223-9665; 7462
dc.issue.numero1
dc.language.isoen
dc.nota.accesocontenido completo
dc.revistaPLOS MEDICINE
dc.rightsacceso abierto
dc.rights.licenseCC0 1.0 Universal
dc.rights.urihttps://creativecommons.org/publicdomain/zero/1.0/
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.titleFactors associated with tuberculosis treatment initiation among bacteriologically negative individuals evaluated for tuberculosis: An individual patient data meta-analysis
dc.typeartículo
dc.volumen22
sipa.codpersvinculados7462
sipa.trazabilidadORCID;2025-03-03
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