Symptom- and chest-radiography screening for active pulmonary tuberculosis in HIV-negative adults and adults with unknown HIV status

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the sensitivity and specificity of questioning for presence of one or more selected symptoms, or symptom combinations, or both; chest radiography; and combinations of those as screening tools for detecting bacteriologically confirmed active pulmonary TB in people considered eligible for TB screening who are HIV-negative or whose HIV-status is unknown. If data allow, we will investigate heterogeneity in relation to: background epidemiology (prevalence of pulmonary TB and of HIV among the study population); risk groups targeted (for example, migrants, occupational, prisoners, or the general population); reference standard (culture, Xpert, smear microscopy); screen test definition; representativeness of the study design and population for intended screening practice (inclusion of people without any symptoms or CXR abnormalities); study participants characteristics (age, sex and HIV status); geographic area and economic region. In the investigation of heterogeneity we intend to stratify for combinations of risk groups or specific populations and background epidemiology, that is, at different levels of TB prevalence among the screened population. We do not intend to do a formal comparison of the accuracy of screening tests as part of this review. As part of the TB screening guideline development process, we will compare diagnostic algorithms as described above.