Diagnosing tuberculosis, Cochrane Special Collections

Tuberculosis (TB) causes more deaths globally than any other infectious disease and is a top 10 cause of death worldwide. When it is detected early and effectively treated, TB is largely curable, but in 2017, around 1.6 million people died of tuberculosis, including 300,000 people living with HIV.[1] Early diagnosis of TB, including universal drug susceptibility testing and systematic screening of contacts and high-risk groups, is a pillar of the World Health Organization (WHO) "End TB" strategy.

The global effort against TB is currently being ramped up as the world enters a new era in the fight against TB. In May 2018, the WHO published the first Essential Diagnostics List, and in September 2018, the United Nations held its first ever High-Level Meeting on TB, galvanizing a global commitment to end the disease by 2030. The High-Level Meeting was the culmination of intensive joint work and collaboration that began with the WHO Global Ministerial Conference on Ending TB in Moscow in November 2017.

The next five years will be critical to ensure this momentum is translated into an accelerated response to End TB. The commitment from the UN High-Level Meeting to finding and treating 40 million people with TB, including 3.5 million children and 1.5 million people with drug-resistant TB, as well as providing preventive treatment to 30 million individuals by 2022, should help to focus efforts.

The WHO Global TB Programme has, for the last decade, led the development of guidelines for diagnostic tests that allow for early and rapid detection of TB and drug-resistant TB. However, sputum smear microscopy remains the primary diagnostic technique in many high TB burden settings, despite being a relatively insensitive test. Microscopy as the initial diagnostic test should be replaced with WHO-recommended rapid diagnostics described in this Special Collection.

This Special Collection, curated by Cochrane contributors, includes Cochrane Reviews from the Cochrane Infectious Diseases Group and other systematic reviews from other international teams. It highlights how Cochrane evidence contributes within a wider landscape of TB evidence and guidelines. The Collection also describes key WHO guidelines on TB diagnostics, and their underpinning systematic reviews, some which are published within the WHO Guideline itself.

This Special Collection covers:

Early detection of TB

Diagnosis of active TB disease and TB drug resistance

Diagnosis of TB in people living with HIV

Diagnosis of TB in children

Diagnosis of latent TB infection.