3.1.1 Summary of the evidence and rationale

The data used to inform this recommendation came from a systematic review of the diagnostic accuracy of using symptoms and chest radiography to detect TB disease among individuals aged 15 years and older with negative or unknown HIV status. The review included studies of screening conducted in the general population (including several prevalence surveys conducted in African and Asian countries), as well as screening conducted in high-risk groups (including contacts of TB patients, prisoners and others). Data from a separate review of the diagnostic accuracy of mWRDs used as a screening tool in individuals from high-risk groups aged 15 years and older (including contacts of TB patients, prisoners and miners, all with negative or unknown HIV status) were also used to inform this recommendation. All data were pooled to estimate the sensitivity and specificity of each screening tool, as there was insufficient evidence to make estimates of accuracy for the screening tools in each high-risk group (the performance of tools among people living with HIV is presented later, in Recommendations 11–15). The reference standard used throughout was bacteriologically confirmed pulmonary TB. Table 3 summarizes the diagnostic accuracy of the screening tools considered (see Web Annex B, Tables 5–10 for more details).

Diagnostic accuracy of symptoms

NA: not applicable.

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