DRAFT-NOT FOR DISTRIBUTION Acceptability of TB Screening Among At-Risk and Vulnerable Groups: A Systematic Qualitative/Quantitative Literature Metasynthesis Ellen M. H. Mitchell Adrienne Shapiro Jonathan Golub Kathrina Kranzer Ana Victoria Portocarrero Camilo Antillón Najlis Jintana Ngamvithayapong-Yanai Knut Lönnroth 1 DRAFT-NOT FOR DISTRIBUTION Table of Contents Acceptability of Screening among At-Risk and Vulnerable Groups: A Systematic Literature Review .................................................................................................................................................................................... 5 Acknowledgements ................................................................................................................................................... 6 ABSTRACT ..................................................................................................................................................................... 7 Structured summary ...................................................................................................................................... 7 INTRODUCTION ............................................................................................................................................ 10 Study Rationale............................................................................................................................................... 10 Study Objective ............................................................................................................................................... 10 Review Protocol ....................................................................................................................................................... 11 Introduction ..................................................................................................................................................... 11 Search Strategy for PICOT: What is the acceptability of systematic screening for active TB among x population in the 1985-April 2011 period? ............................................................. 13 Inclusion Criteria .......................................................................................................................................... 13 Data collection process .............................................................................................................................. 15 Quantitative search strategy .................................................................................................................... 15 Data items ......................................................................................................................................................... 15 Qualitative data search strategy ............................................................................................................. 15 Risk of bias in individual studies ............................................................................................................. 16 Summary measures ..................................................................................................................................... 16 Data analysis ................................................................................................................................................... 16 Results.......................................................................................................................................................................... 17 Study selection .............................................................................................................................................. 17 Study characteristics ................................................................................................................................... 19 Risk of bias within studies ......................................................................................................................... 19 Synthesis of results ...................................................................................................................................... 19 Qualitative Results on Acceptability of Screening ........................................................................... 20 Incentives and enablers as a determinant of acceptability of TB screening ......................... 20 A note on gender as a determinant of TB screening acceptability ............................................ 21 1. Adolescents ........................................................................................................................................... 22 2. Alcohol dependent ............................................................................................................................. 22 3. Attendees of health care facilities ................................................................................................ 23 4. Children under 5 ................................................................................................................................. 23 5. Diabetics ................................................................................................................................................ 24 6. Drug dependent .................................................................................................................................. 24 7. Elderly ..................................................................................................................................................... 25 2 DRAFT-NOT FOR DISTRIBUTION 8. Malnourished ....................................................................................................................................... 25 9. Mentally Ill ............................................................................................................................................ 26 10. Persons with Previous TB............................................................................................................... 26 11. PLHIV ....................................................................................................................................................... 26 12. Pregnant women ................................................................................................................................ 27 13. Persons seeking VCT ......................................................................................................................... 28 14. Smokers .................................................................................................................................................. 28 15. Factory & Farm workers ................................................................................................................. 29 16. Health care workers .......................................................................................................................... 30 17. Miners ..................................................................................................................................................... 31 18. Orphans and minors in congregate settings. .......................................................................... 31 19. Prisoners ................................................................................................................................................. 32 20. Refugees and internally displaced persons. ............................................................................ 33 21. Residents of Urban poor areas ..................................................................................................... 34 22. Soldiers and Military personnel ................................................................................................... 34 23. Transportation workers .................................................................................................................. 34 24. Homeless ............................................................................................................................................... 35 25. Indigenous............................................................................................................................................. 36 26. Migrants ................................................................................................................................................. 37 27. Marginalized Men who have Sex with Men (MSM) .............................................................. 38 28. Nomadic /Pastoralist populations .............................................................................................. 38 29. Sex workers .......................................................................................................................................... 38 30. Street children / abandoned children/ out of school youth ............................................ 39 31. Transgender ......................................................................................................................................... 39 32. Screening of Contacts of a TB Case .............................................................................................. 40 Risk of bias across studies ......................................................................................................................... 42 DISCUSSION ..............................................................................................................................................................