EVidence to Inform South African TB policies: EVISAT Project

To contribute to evidence-informed policy development in South Africa, the EVISAT: Evidence to Inform South African Tuberculosis policies project, led by the CEBHC, provided oversight, quality assurance and management for the conduct of robust systematic reviews on the epidemiology of and programmatic response to Tuberculosis (TB) in South Africa, while taking stock of international systematic review evidence on strategies to prevent, diagnose, manage and offer services to those with TB.

New systematic reviews

The project commenced with meetings with WHO and National Department of Health to clarify the review questions. Six new systematic reviews were then conducted by six review teams consisting of both TB and systematic review methodology experts. Each review assessed the epidemiology and programmatic response to TB within a specific vulnerable population.

For full text of new systematic reviews visit: http://www.afro.who.int/en/south-africa/country-programmes/4247-tuberculosis-tb.html

Summaries of existing systematic reviews on TB

 We identified a large number of existing systematic reviews of the effects of interventions to prevent, diagnose, treat and offer health services to those with TB. At the EVISAT national stakeholder consultation participants reviewed a comprehensive list of existing systematic reviews on TB and selected the reviews that were most relevant to them. Based on this selection process a shortlist of existing systematic reviews was generated. Evidence summaries of these reviews were conducted.

Reviews summarised
Storla DG, Yimer S, Bjune GA. A systematic review of delay in the diagnosis and treatment of Tuberculosis. BMC Public Health 2008, 8:15
Volmink J, Garner P. Directly observed therapy for treating tuberculosis. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD003343.pub2.
Fox GJ, Dobler CC, Marks GB. Active case finding in contacts of people with tuberculosis. Cochrane Database of Systematic Reviews 2011, Issue 9.
M’Imunya JM,KredoT,Volmink J. Patient education and counselling for promoting adherence to treatment for tuberculosis. Cochrane Database of Systematic Reviews 2012, Issue 5.
Lutge EE, Wiysonge CS, Knight SE, Volmink J. Material incentives and enablers in the management of tuberculosis. Cochrane Database of Systematic Reviews 2012, Issue 1.
Uyei J, Coetzee D, Macinko J, Guttmacher S. Integrated delivery of HIV and tuberculosis services in sub-Saharan Africa: a systematic review. Lancet Infect Dis. 2011 Nov;11(11):855-67
Liu Q, Abba K, Alejandria MM, Balanag VM, Berba RP, Lansang MAD. Reminder systems and late patient tracers in the diagnosis and management of tuberculosis. Cochrane Database of Systematic Reviews 2008, Issue 4.
Joshi, R., et al., Tuberculosis among health-care workers in low- and middle-income countries: a systematic review. PLoSMed, 2006. 3(12): p. e494.
Al-Darraji H.A.A., Kamarulzaman A., F. L. Altice F. L. Isoniazid preventive therapy in correctional facilities: a systematic review.Int. J. Tuberc. Lung. Dis. 2012: 16(7): 871–879
Gray DM, Young T, Cotton M, Zar H. Impact of tuberculosis preventive therapy on tuberculosis and mortality in HIV-infected children. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD006418. DOI:
Steingart KR, Sohn H, Schiller I, Kloda LA, Boehme CC, Pai M, Dendukuri N. Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database of Systematic Reviews 2013, Issue 1.

The World Health Organization (WHO) commissioned the EVISAT project in support of the South Africa National Department of Health. USAID and the Joint United Nation Programme on HIV/AIDS funded the EVISAT project.  The Centre for Evidence-based Health Care (CEBHC) www.sun.ac.za/cebhc in collaboration with the Desmond Tutu TB Centre (DTTC) www.sun.ac.za/tb, and the Health Systems and Services Research (HSSR) Unit at Stellenbosch University managed the EVISAT project.