Table 1

Characteristics of studies applying different service models and organisational structures to improve TB identification and TB management

First author (year), countryPopulationAimsInterventionComparatorStudy designOutcome measureQuality score
TB identification (studies identified by this review)
 Jit22 (2011),
Homeless people and drug users.To assess the effectiveness and cost-effectiveness of the Find and Treat service for diagnosing and managing hard-to-reach individuals with active TB in London.Period 2007–2010: Find and Treat service:
  • Screening by MXU.

  • Peers raising awareness.

  • Treatment support.

Passive case detection and standard treatment at a London TB clinic.Observational and cost-effectiveness study.Identified TB cases, treatment completion, lost to follow-up and incremental costs from healthcare taxpayer perspective.+
 Duarte11 (2011),
Drug users.To evaluate the effect of an intervention with key partners (TB clinic, drug users support centres, shelters, street teams, public health department and hospital) delivering promotion of health-seeking behaviour, eliminating potential barriers for TB screening at a chest clinic and DOT on identifying TB cases and treatment compliance.Improved cooperation of key partners (2005–2007):
  • Health education and screening promotion.

  • Improved screening procedures.

  • Implementation of DOT.

  • Free TB care and transport.

  • Providing medical and drug abuse treatment.

  • Active follow-up of non-compliant patients, the key partners worked together to reach the patient, identify the cause and organise suitable treatment strategies.

Period before the intervention (2001–2003):
  • No active screening policy.

  • Referral to chest clinic after discharge from hospital.

  • Treatment not compulsory.

  • Information about disease and treatment given to improve compliance.

  • Psychosocial support.

  • Free TB treatment, transport and breakfast.

Before–after study.Identified TB cases and treatment compliance.
 Goetsch20 (2012),
Homeless people and drug users.To estimate the coverage of a low-threshold CXR screening programme for pulmonary TB among illicit drug users and homeless persons.CHWs providing TB education and promoting voluntary CXR screening 1–2×/year.Comparing the beginning of the 5-year intervention period with the end (2002–2007).Retrospective effectiveness study.Screening coverage.
 Ospina21 (2012),
Migrants.To evaluate the effectiveness of an intervention with CHWs to improve contact tracing among migrants.CHWs active follow-up of cases and contacts, including visits of the cases at home, accompanying at outpatient appointments, providing counselling and information on treatments (2003–2005).Preintervention period (2000–2002).Before–after study.Number of migrants who were included in contact tracing.+
 Aldridge19 (2015),
Homeless people.To compare TB screening uptake between current practice of encouraging homeless people by shelter staff and encouragement by shelter staff plus volunteer peer educators.Encouragement of TB screening by peers in addition to shelter staff.Encouragement of TB screening by shelter staff only.Cluster RCT.Screening uptake.+
TB identification (studies identified by the previous NICE review15)
 El-Hamad24 (2001),
MigrantsTo compare the completion rates of screening procedures for TB infection among undocumented migrants at specialised TB units and non-specialised health clinics.TB screening at specialised TB clinic.TB screening at a general health service for migrants.Prospective cohort.Screening completion.+
 Bothamley25 (2002),
Migrants and homeless people.To compare the yield and costs of TB screening in three settings: a new entrants’ clinic within the POA scheme; a large general practice; and centres for the homeless.TB screening at a GP.TB screening at POA and at homeless centres.Cost analysis.Cost per person screened per case of TB prevented.
 Deruaz28 (2004),
Migrants, alcohol or drug users, homeless people and prisoners.Evaluation of first experience of the DOT programme for TB introduced in the Canton of Vaud in 1997.
  1. Full DOT.

  2. DOT delivered at TB clinic.

  1. Partial DOT (DOT only first 2 months of treatment).

  2. DOT delivered at social outreach site.

Before–after study.Adherence to treatment and outcome.
 Miller26 (2006),
Homeless people and prisoners.To evaluate and compare the efficiency of a non-state-law-mandated TB screening programme for homeless persons with a state-law-mandated TB screening programme for prisoners.Non-state-law-mandated TB screening programme for homeless persons.State-law-mandated TB screening programme for prisoners.Retrospective comparison of the cost and health impacts.TB cases averted and cost.+
 Ricks23 (2008),
Drug users.To compare the effectiveness of using peers versus ‘standard’ public health workers to coordinate TB treatment.Enhanced case management by peers.Limited case management by healthcare professionals.RCT.Adherence to treatment.++
 Mor27 (2008),
Migrants.To examine the effectiveness and cost-effectiveness of premigration screening and postmigration screening at POA.Premigration screening.Postmigration screening.Retrospective cohort analysis.Active TB cases, time between migration and diagnosis, and cost-savings.
  • Study quality: high quality [++], medium quality [+] or low quality [−].

  • CHWs, community health workers; CXR, chest X-ray; DOT, direct observed treatment; GP, general practice; MXU, mobile X-ray unit; n, number of participants; POA, port of arrival; RCT, randomised controlled trial; TB, tuberculosis.