Article type
Year
Abstract
Background:
The Cochrane Collaboration is finding effective mechanisms for aligning intervention reviews and global guidelines processes, but experience with diagnostic test accuracies (DTA) reviews appears limited. Here we report on how an effective linkage between a Cochrane Review Group and the World Health Organization’s (WHO) global tuberculosis (TB) programme.
Approach:
In early 2011, WHO issued policy recommendations on Xpert® MTB/RIF (Xpert), a new test that can simultaneously detect TB and TB drug resistance in around two hours. In 2013, given additional data on Xpert, WHO convened a process to update recommendations, including commissioning of DTA reviews. The Cochrane Editor is a member of 'STOP TB Partnership’s New Diagnostic Working Group' and participates in consideration of new TB tests. The Cochrane Editor worked with (1) researchers in the field and Cochrane Infectious Diseases Group (CIDG) to prioritize topics; (2) WHO to formulate PICO questions; (3) biostatisticians to perform data analysis; and (4) the Cochrane Managing Editor to ensure rapid production of the Xpert review1. Based on this approach, two new DTA reviews are underway.
Results:
The updated Cochrane Review on Xpert included 27 studies (integrating nine new studies) and was presented at the WHO Expert Group meeting in May 2013. The review found: in adults thought to have TB, with or without HIV infection, Xpert is accurate for detection of TB and rifampicin resistance and can allow for rapid initiation of treatment for multi-drug-resistant TB. Updated WHO recommendations on Xpert were issued October 2013; the updated Xpert review was published open access January 2014. For the second review (MTBDRsl), we are completing data analysis; for the third (urine lipoarabinomannan), we are writing the protocol.
Conclusion:
Despite complexity of DTA reviews, it is possible with teamwork and leadership to ensure reviews are prioritized and completed within WHO timelines.
The Cochrane Collaboration is finding effective mechanisms for aligning intervention reviews and global guidelines processes, but experience with diagnostic test accuracies (DTA) reviews appears limited. Here we report on how an effective linkage between a Cochrane Review Group and the World Health Organization’s (WHO) global tuberculosis (TB) programme.
Approach:
In early 2011, WHO issued policy recommendations on Xpert® MTB/RIF (Xpert), a new test that can simultaneously detect TB and TB drug resistance in around two hours. In 2013, given additional data on Xpert, WHO convened a process to update recommendations, including commissioning of DTA reviews. The Cochrane Editor is a member of 'STOP TB Partnership’s New Diagnostic Working Group' and participates in consideration of new TB tests. The Cochrane Editor worked with (1) researchers in the field and Cochrane Infectious Diseases Group (CIDG) to prioritize topics; (2) WHO to formulate PICO questions; (3) biostatisticians to perform data analysis; and (4) the Cochrane Managing Editor to ensure rapid production of the Xpert review1. Based on this approach, two new DTA reviews are underway.
Results:
The updated Cochrane Review on Xpert included 27 studies (integrating nine new studies) and was presented at the WHO Expert Group meeting in May 2013. The review found: in adults thought to have TB, with or without HIV infection, Xpert is accurate for detection of TB and rifampicin resistance and can allow for rapid initiation of treatment for multi-drug-resistant TB. Updated WHO recommendations on Xpert were issued October 2013; the updated Xpert review was published open access January 2014. For the second review (MTBDRsl), we are completing data analysis; for the third (urine lipoarabinomannan), we are writing the protocol.
Conclusion:
Despite complexity of DTA reviews, it is possible with teamwork and leadership to ensure reviews are prioritized and completed within WHO timelines.