Abstract
Screening for Latent Tuberculosis Infections (LTBI) constitutes a key step in health surveillance programs especially among adults of high-risk groups. To our knowledge, this is the first systematic and meta-analysis review that aims to critically assess and compare the agreement of QuantiFERON-TB Gold In-Tube (QFT-GIT) and Tuberculin Skin Testing (TST) among adults of high-risk groups in Saudi Arabia and compare results with other sites of the Middle East. Kappa estimates were meta-analyzed using random effect model and several subgroup analyzes were performed to explain overall heterogeneity. Funnel plot, Begg's and Egger's tests were employed to assess overall publication bias. 18 studies were meta-analyzed, comprising 5070 adults of high-risk groups. Pooled kappa estimates from Saudi Arabia (κ = 0.29, 95% CI: 0.16, 0.41) showed lower rate of agreement compared to other sites of the Middle East (κ = 0.33, 95% CI: 0.25, 0.41). However, a significant level of heterogeneity (I2 = 96.7%, p > 0.001) were identified across collected evidence. Begg's and Egger's tests confirmed absence of significant publication bias in this review (p = 0.49 and p = 0.16, respectively). This work revealed fair to poor agreement between TST and QFT-GIT, indicating that these two tests are not interchangeable in such settings. Substantial evidence is still needed before considering the sole use of QFT-GIT as an alternative to TST in these populations. Moreover, there is an urgent need for longitudinal studies in Saudi Arabia and the Middle East to accurately assess precision of LTBI diagnosis.
Highlights
Screening for Latent Tuberculosis Infections (LTBI) constitutes a key step in health surveillance programs especially among adults of high-risk groups
Lists of retrieved citations were carefully analyzed, and we found that the main era of publications meeting our set of criteria and objectives in Saudi Arabia and subsequently in other sites of the Middle East is between January 2013 to March 2017
A total of 265 publications were identified from different electronic databases, of which 18 of them met the above mentioned criteria and were included in this review (Figure 1): 6 from Saudi Arabia [22,23,24,25,26,27], 5 from Turkey [28,29,30,31,32], 3 from Iran [33,34,35], 2 from Egypt [36,37], 1 from Oman [38] and 1 from Qatar [39]
Summary
Screening for Latent Tuberculosis Infections (LTBI) constitutes a key step in health surveillance programs especially among adults of high-risk groups. To our knowledge, this is the first systematic and meta-analysis review that aims to critically assess and compare the agreement of QuantiFERON-TB Gold In-Tube (QFT-GIT) and Tuberculin Skin Testing (TST) among adults of high-risk groups in Saudi Arabia and compare results with other sites of the Middle East. Early LTBI detection is remarkably hindered by the absence of gold standard diagnostic tools and limited efficiency of available diagnostic tools, developed and utilized for clinical use alone These tools are Tuberculin Skin Test (TST) and InterferonGamma Release Assays (IGRAs). IGRAs comprise both QuantiFERON-TB Gold In-Tube (QFT-GIT; Cellestis Ltd, Carnegie, Australia) and T-SPOT.TB test (T-SPOT; Oxford Immunotec Inc, Abingdon, UK) [4]
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