Diagnosing tuberculosis,Cochrane Special Collections

Tuberculosis 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, tuberculosis is largely curable. In 2018, around 10 million people developed tuberculosis disease (similar to the number in the past several years). In 2018, around 1.2 million HIV-negative people died from tuberculosis (a 27% decrease from 1.7 million in 2000), and around 251,000 HIV-positive people died from tuberculosis (a 60% decrease from 620,000 in 2000).[1] In addition, there were approximately half a million new cases of rifampicin-resistant tuberculosis, with India (27%), China (14%) and the Russian Federation (9%) accounting for the largest burden.[1] Early diagnosis of tuberculosis, including universal drug susceptibility testing and systematic screening of contacts and high-risk groups, is part of pillar one of the World Health Organization (WHO)’s "End TB" strategy.

The global effort against tuberculosis is currently being ramped up as the world enters a new era in the fight against tuberculosis. 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 ending tuberculosis, 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 several 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 tuberculosis, including 3.5 million children and 1.5 million people with drug-resistant tuberculosis, 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 tuberculosis and drug-resistant tuberculosis. However, sputum smear microscopy remains the primary diagnostic technique in many high tuberculosis 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 tuberculosis evidence and guidelines. The Collection also describes key WHO guidelines on tuberculosis diagnostics, and their underpinning systematic reviews, some which are published within the WHO Guideline itself.

This Special Collection covers:

Early detection of tuberculosis

Diagnosis of active tuberculosis disease and tuberculosis drug resistance

Diagnosis of tuberculosis in people living with HIV

Diagnosis of tuberculosis in children

Diagnosis of latent tuberculosis infection.