Effectiveness of home visiting on tuberculosis case detection: Systematic review and meta-analysis.

Background: Tuberculosis (TB) is a public health agenda globally. Most TB cases are detected using the usual passive method. Starting a decade, cases are detected using an active detection strategy. The home-visiting strategy is one of the active case findings approaches. However, no study shows the pooled effect of home visiting on tuberculosis case detection rate. Thus, we conducted this study to evaluate the effectiveness of home visiting on tuberculosis case detection.

Methods: In this systematic review and meta-analysis, the PRISMA checklist was used to report findings. A systematic comprehensive search was done to address all possible search databases. We used to search databases such as PubMed/MEDLINE, Scopus, and Science Direct to identify relevant articles. Data were extracted by two authors and consistency was checked by two co-authors. Cochrane risk of bias tool was used to assess the quality of studies. Data were extracted using a Microsoft Excel spreadsheet then; data were transferred to Stata version 16 for further analysis. Heterogeneity across studies was checked using the Q statistics (I2).

Results: Overall, 4174 articles were found. Two thousand one hundred seventy-five (2175) articles were excluded due to duplications. One thousand nine hundred twenty-four articles were excluded after reviewing titles and abstracts. Seventy-five articles were assessed using their full texts articles and 70 articles were excluded with unclear outcomes and poor methodological quality. Finally, 5 articles were selected for the final analysis. In all studies, the case-notification rate was significantly increased in the intervention arm than the control arm. The pooled effect size was RR: 1.65 (95% CI: 0.92, 2.39). This study showed that there was a significant heterogeneity (I2 = 98.9%, P < 0.001). Visual examination of the funnel plot showed asymmetric distribution. However, the egger's and bigger tests showed there was no significant publication bias ((P = 0.313).

Conclusion: Home to home visiting is an effective TB case finding method as compared to the usual passive detection methods. The health system should be strengthened home to home visiting to enhance TB case detection. The protocol PROSPERO registration was CRD42021227860.