Samuel R Pierce, Kerstin M Palombaro, Jill D Black
Barriers to bicycle helmet use in young children in an urban elementary school
Health promotion practice
tuberculosis preventable disease however debate regarding individuals would benefit tuberculosis preventive treatment whether benefits vary settings high burden low burden tuberculosis aimed compare effectiveness tuberculosis preventive treatment exposed individuals differing ages mycobacterium tuberculosis infection status considering tuberculosis burden settings systematic review individualparticipant metaanalysis investigated development incident tuberculosis people closely exposed individuals tuberculosis searched studies published jan 1 1998 april 6 2018 medline web science biosis embase restricted search cohort studies casecontrol studies outbreak reports excluded two reviewers evaluated titles abstracts full text articles eligibility stage two reviewers discussed discrepancies reevaluated articles consensus reached individualparticipant data prespecified list variables including characteristics exposed contact index patient environmental characteristics requested authors eligible studies contacts exposed drugresistant tuberculosis index patient excluded primary study outcome incident tuberculosis estimated adjusted hazard ratios ahrs incident tuberculosis mixedeffects cox regression models studylevel random effect estimated numberneededtotreat nnt prevent one person developing tuberculosis propensity score matching procedures used analyses study registered prospero crd42018087022 screening 25 358 records eligibility 439 644 participants 32 cohort studies included individualparticipant data metaanalysis participants followed 1 396 413 personyears median 27 years iqr 1344 2496 people diagnosed incident tuberculosis overall effectiveness preventive treatment 49 ahr 051 95 ci 044060 participants positive tuberculinskintest tst ifn release assay igra result baseline benefitted greater protection regardless age 009 005017 children younger 5 years 020 015028 individuals aged 517 years 017 013022 adults aged 18 years older effectiveness preventive treatment greater highburden 031 023040 versus lowburden 058 047072 settings nnt ranged 9 34 depending age among participants positive tst igra highburden lowburden settings among contacts regardless tst igra test result nnt ranged 29 43 highburden settings 213 455 lowburden settings findings suggest risktargeted strategy prioritising contacts evidence tuberculosis infection might indicated lowburden settings broad approach including contacts considered highburden settings preventive treatment similarly effective among contacts ages none