READ-It update on high impact reviews (May and June 2019)

30 Jul 2019

In May and June 2019, READ-It has published three high-impact reviews through the CIDG. The full-text open access articles are listed below.

Some donors and malaria specialists are pushing indoor residual spraying (IRS) to be added to insecticide-treated nets (ITNs) where ITNS are failing due to pyrethroid resistance. This review examines the evidence, stratified by IRS insecticide that is ‘non-pyrethroid-like’ and thus more likely to work theoretically where pyrethroid resistance is emerging. The results are mixed, with no clear evidence of an additional benefit in this group. When ‘pyrethroid-like’ insecticide is used, no benefit has yet been shown. There really is no clear evidence to add IRS to ITNS if the purpose is to increase malaria vector control effectiveness. Used in: WHO Malaria Vector Control Guidelines (Feb 2019)

Xpert MTB/RIF and Xpert Ultra, the newest version, are the only WHO-recommended rapid tests that simultaneously detect tuberculosis and rifampicin resistance in people with signs and symptoms of tuberculosis and are suitable for use at lower levels of the health system. This Cochrane Review assessed the diagnostic accuracy of Xpert MTB/RIF and Xpert Ultra for active pulmonary TB in adults. The update incorporates 77 new studies and shows that Ultra has a higher sensitivity but marginally low specificity.

This review is important to provide high-quality information on Xpert MTB/RIF and Ultra; given the investment, having solid evidence base from a synthesis related to these tests is an important contribution. There have been previous WHO Guidelines that have drawn on earlier versions of this review, and this review is likely to help underpin future recommendations arising from the consultation in 2017 (https://www.who.int/tb/publications/2017/XpertUltra/en/). Read the LSTM news item.

Offering ART within 7 days of HIV diagnosis results in greater viral suppression at 12 months may improve retention in care. However, the trials included many co-interventions to help with retention. Whilst the review underpins WHO policy, there is emerging programmatic data that the benefits seen in the trials and documented in the review are not translating to in practice-one can speculate this relates to these co-interventions.

READ-It also published Cochrane Reviews in high-priority topic areas-nutrition and in TB:

 

These publications are associated with the Research, Evidence and Development Initiative (READ-It). READ-It (project number 300342-104) is funded by UK aid from the UK government; however, the views expressed do not necessarily reflect the UK government’s official policies.