Evidence-Based Tuberculosis Diagnosis 英文参考文献.docVIP

Research in Translation Evidence-Based Tuberculosis Diagnosis Madhukar Pai , Andrew Ramsay, Richard O’Brien * T here is great excitement in the tuberculosis (TB) scientific community over the introduction steps involved in the policy process include a comprehensive review of the evidence, as well as expert opinion and judgment (Box 1). High-quality evidence on TB diagnostics is critical for the in the latter setting. However, meta- analyses on IGRAs have highlighted the lack of evidence on the predictive ability of these assays in identifying those individuals with TB infection who are at highest risk for progressing to active disease. Several cohort studies are ongoing (reviewed elsewhere [39]), and these should provide useful evidence on this unresolved issue. For active TB, serological tests have been attempted for decades. Two meta-analyses have convincingly shown that existing commercial antibody- based tests have poor accuracy and limited clinical utility [29,30]. Despite this evidence, dozens of commercial serological tests continue to be of new tools into TB control activities. The development of new tools is an important component of the Global Plan to Stop TB and the World Health Organization’s new global Stop TB Strategy [1,2]. Anticipating the introduction of new tools, the Stop TB Partnership has established a Retooling Task Force to develop a framework for engaging policy makers to foster accelerated adoption and implementation of new tools into TB control programs [3]. While new tools offer great promise in clinical medicine and in public health, limited resources and the movement toward evidence-based guidelines and policies require careful validation of new tools prior to their introduction for routine use. The world spends an estimated US$1 billion per year on diagnostics for TB [4]. It is important to ensure that such expenditure is backed by strong evidence. development of evidence-based policies on TB diagnosis, and, ultimately, for effectiv