The cascade-of-care for tuberculosis infection in low-incidence countries : scoping review protocol.
Date: 2024-04-05
Institutions: European Centre for Disease Prevention and Control
Subjects: UNO, disease prevention, disease surveillance, health care, infectious disease, medical diagnosis, protocol, public health, sustainable development

TECHNICAL REPORT 

The cascade-of-care for tuberculosis infection in 
low-incidence countries – a scoping review 
protocol 

Introduction 

Ending tuberculosis (TB) by 2030 is one of the targets outlined in the Sustainable Development Goals [1]. To 
achieve this goal it is necessary to implement a comprehensive strategy, including several interventions to prevent, 
diagnose and treat TB in a timely and effective manner [2]. Among these interventions, management of TB 
infection is considered essential [3]. 

TB infection, also known as latent TB infection (LTBI), is defined as ‘a state of persistent immune response to 
stimulation by Mycobacterium tuberculosis antigens with no evidence of clinically manifest active TB' [4]. People 
with TB infection have no signs or symptoms of TB and are considered to be at risk of progressing to TB disease. 
TB preventive treatment should be offered to those who have been exposed to TB or who are infected with TB to 
avoid progression to active TB disease [5]. 

Approximately one-fourth of the world’s population is infected with TB [6]. In Europe alone, the prevalence of TB 
infection has been estimated at between 11 and 15% [7]. Delivering systematic screening of TB infection in at-risk 
populations and provision of TB preventive treatment are key components of the global TB elimination strategy, 
particularly in countries with low TB incidence (i.e. with a notification rate <10 TB cases per 100 000 
population) [3,8]. A majority of the Member States of the European Union (EU) and European Economic Area 
(EEA) have a low TB incidence [3].  

Rationale 

The management of TB infection involves the sequential implementation of key interventions, a process that has 
been labelled as cascade-of-care [9]. The concept cascade-of-care (or continuum of care), is also an analytical 
framework used to evaluate public health interventions by constructing models of the proportion of people 
completing sequential steps of care for a given condition or disease [10]. 

Cascade-of-care analyses have been applied to both TB disease and TB infection [9,11-13]. For the latter, 
systematic and scoping reviews have focussed on specific at-risk populations and/or settings with high-TB burden 
[14-16]. So far, information on data sources and analytical decisions on how to conduct cascade-of-care analyses 
for TB infection have not been mapped in sufficient detail, as has been done for other diseases [17-19]. In an 
exploratory search conducted in August 2023 there were no ongoing systematic or scoping reviews identified on 
this topic in three open-access repositories (PROSPERO [20], OSF Registries [21]  and Figshare [22]). 

Suggested citation: European Centre for Disease Prevention and Control. The cascade-of-care for tuberculosis infection in low-
incidence countries. Stockholm: ECDC; 2024. 
Stockholm, February 2024 
ISBN 978-92-9498-688-7 
doi: 10.2900/471944 
Catalogue number TQ-02-24-158-EN-N 

© European Centre for Disease Prevention and Control, 2024. Reproduction is authorised, provided the source is acknowledged. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
TECHNICAL REPORT 

The cascade-of-care for tuberculosis infection in low-incidence countries – a scoping review protocol 

The purpose of this scoping review will therefore be to describe and summarise the rationale behind and 
methodological approaches used to conduct cascade-of-care analyses for TB infection in low-TB incidence countries. 
Knowledge users, defined as ‘those who have a vested interest in the research, its outcomes and impacts’ [23], will 
be involved throughout the review process, including the identification of relevant publications and the discussion of 
findings to inform surveillance and monitoring strategies for TB infection at national and regional levels in the EU/EEA. 

Review questions 

Table 1 below presents the questions for the scoping review. 

Table 1. Review questions 

Type of question 

Review question 

Main question 

Secondary questions 

Why and how have cascade-of-care analyses for TB infection been implemented in low-TB 
incidence countries? 
•  What was the purpose of the cascade-of-care analysis? 
•  Which key populations have been monitored? 
•  What data sources have been used for constructing cascade-of-care analyses? 
•  Which steps of the cascade-of-care are commonly reported?  
•  Which methods have been used to construct cascade-of-care analyses? 
•  Which and what type of indicators have been used in cascade-of-care analyses for TB 

infection? 

•  What challenges and/or lessons learned have been identified? 

This protocol has been developed based on the best practice guidance proposed by Peters et al [24], as presented 
in Annex 1, and will be available on the European Centre for Disease Prevention and Control (ECDC) website. 

The scoping review will be conducted according the JBI scoping review methodology [25,26] and reported 
following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews 
(PRISMA-ScR) [27] and the Guidance for Reporting Involvement of Patients and the Public (GRIPP 2) [28].  

Methods 

Eligibility criteria 
Sources of evidence will be eligible for inclusion in the scoping review if they fulfil the criteria below. These criteria 
were defined using the PCC framework (i.e. participants, concepts and context) [25]. 

Participants 
Publications that will be considered for inclusion in the scoping review are those reporting on people (i.e. adults, 
adolescents and children) assessed for eligibility for TB preventive treatment (i.e. with or without a screening test 
for TB infection), irrespective of concomitant risk factors and/or comorbidities, where at least two consecutive 
steps of the cascade-of-care process for TB infection (as defined below) are described. 

Publications reporting on people with confirmed TB disease (also referred to as active TB), including any drug-
resistant form of the disease, will be excluded from this review. 

Concepts 
The concepts to be explored relate to the methodological approaches used to estimate and report care cascade 
analyses for TB infection. 

For the purposes of this scoping review, the steps of the TB infection care cascade have been pre-defined, based 
on existing models [5,9,14,29], as set out below. 

1. 

Initially identified for assessment of TB preventive treatment eligibility, either by using: 

a. 

b. 

Screening tests for TB infection, in which case two additional steps will be considered, namely: 
−  tested for TB infection (irrespective of the diagnostic test used); 
−  received positive test results. 
Clinical assessment of risk factors (i.e. people at higher risk of progressing to active TB if infected). 

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TECHNICAL REPORT 

The cascade-of-care for tuberculosis infection in low-incidence countries – a scoping review protocol 

2. 
3. 
4. 
5. 
6. 

Referred for medical evaluation (to rule out active TB). 
Completed medical evaluation. 
Offered TB preventive treatment (irrespective of treatment regimen indicated). 
Started TB preventive treatment. 
Completed TB preventive treatment. 

Cascade-of-care models will be characterised in terms of their breadth (i.e. range of staging from the initial to the 
final event of the cascade) and depth (i.e. number of steps within a given breadth) [30].  

Analytical approaches to estimating the care cascade will be described based on the type of data linkage, 
population and time horizon. Data linkage will be defined as denominator-denominator (i.e. if the same group of 
people can be assessed across all the steps, using individually linked data) or denominator-numerator (i.e. all those 
eligible for inclusion in the numerator in a given step are included in the denominator of the same step by using 
‘linked’ individual data or ‘unlinked’ aggregated data) [30]. The population will be defined as single (i.e. same 
underlying population across all the steps) or multiple (i.e. data are drawn from different populations) [30]. The 
time horizon will be defined as longitudinal, (if people are followed over time) or cross-sectional (if observations 
are made at one point in time) [30]. 

Depending on the aim of the cascade-of-care analysis, public health indicators could focus on patient outcomes to 
monitor programme performance or (i.e. outcome indicators) or processes to better understand the quality of care 
(i.e. process indicators) [5,11]. 

Narrative comments on challenges and/or lessons learned, as reported by the authors, will be collected (if applicable). 

Context 
The scoping review will focus on the epidemiological context of low-TB incidence countries, from the perspective of 
surveillance and monitoring programmes for TB infection. Therefore, only publications reporting primary data from 
countries with a TB notification rate <10 cases per 100 000 population (as per latest surveillance data from ECDC 
and/or the World Health Organization) will be considered for inclusion. 

Type of evidence source 
Primary studies −both peer-reviewed and grey literature − with any of the following study designs will be 
considered for inclusion: observational studies (cohort and cross-sectional), randomised control trials, qualitative 
studies, systematic reviews and scoping reviews. 

Editorials, commentaries and case reports will be excluded, as well as earlier versions of a publication (e.g. pre-
prints or conference abstracts of a final peer-reviewed article). 

Publications focussing only on the diagnostic accuracy of screening tests for TB infection, assessing the efficacy of 
TB preventive treatment regimens or analysing cost-effectiveness will be excluded. 

No language restriction will be applied in the eligibility assessment. 

Search strategy 

Four databases − PubMed, Embase, Scopus and Cochrane Database of Systematic Reviews − will be searched to 
identify data sources published after 1 January 1990. This cut-off date is used based on the findings of the first 
systematic review reporting on care cascade for TB infection [9], which identified relevant studies on the topic 
from 1990 onwards. The search strategy will be informed by search terms used in previously published systematic 
and scoping reviews on TB infection and further developed with the assistance of an information specialist. No 
study design or language limits will be applied for the search. 

The final search strategy will be defined using an iterative process of preliminary searches for identification of 
relevant search terms. Annex 2 includes the draft of the search strategy for three databases. 

A second information specialist, (not involved in this project) will peer-review the final search strategy using the 
Peer Review of Electronic Search Strategies (PRESS) checklist [31]. 

In addition, backwards and forwards citation chasing1 [32] of all selected publications will be performed, and email 
search alerts will be established for the above-listed databases to keep the review team informed of any new 
studies published after the search is conducted. Knowledge users will also be consulted (more details in the section 
‘Knowledge user engagement’). 

1 A process that uses connections between similar publications to identify additional relevant records. 

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TECHNICAL REPORT 

The cascade-of-care for tuberculosis infection in low-incidence countries – a scoping review protocol 

Selection process 

The selection process will consist of the following steps: 

1. 

2. 

3. 

4. 

De-duplication: all publications identified in the selected databases will be collated and imported into 
EndNote (Clarivate Analytics, Philadelphia, US) and duplicates will be removed from the dataset. 
Abstract and title screening supported by artificial intelligence (AI): unique references (i.e. the de-
duplicated dataset) will be uploaded to ASReview, an open-source AI tool [33] which uses active machine 
learning to rank publications according to relevance. Two independent reviewers will assess the title and 
abstract against the eligibility criteria, using a researcher-in-the-loop pipeline supported by ASReview. In 
this pipeline, all inclusion decisions are made by the reviewer and a stop criterion (e.g. pre-defined 
parameters to decide when to stop screening) is required [34]. After pilot testing ASReview for the purpose 
of this scoping review, the stop criterion was defined as follows: each reviewer will continue screening until 
reaching 100 consecutive title/abstracts labelled as ‘irrelevant’ after screening at least 30% of the dataset. 
All citations labelled as ‘relevant’ by both reviewers will undergo full-text screening. Any disagreement will 
be discussed by the reviewers until an inclusion or exclusion decision is reached. 
Full-text screening: publications labelled as 'relevant’ will be uploaded to Covidence (Veritas Health 
Innovation, Melbourne, Australia), a web-based application for collaborative screening and data extraction. 
Two independent reviewers will assess the full text of pre-selected publications against the eligibility criteria. 
Any discrepancies between the two reviewers will be resolved by consensus. If consensus cannot be 
reached, a third reviewer will be consulted until final decision is reached. 
Screening additional results from other sources: unique citations (i.e. new to the dataset) identified 
through backwards and forwards citation chasing, or email alerts, or suggested by knowledge users will 
undergo a two-step screening (e.g. title/abstract and full text) by two independent reviewers using 
Covidence. 

Check lists for the title/abstract and full text screening will be developed to ensure that a consistent approach is 
applied by all reviewers (Annex 3). The review team will pilot test the inclusion/exclusion criteria before initiating 
the screening and discuss any challenges encountered during the screening process on a weekly basis. If 
necessary, the screening procedures will be adapted during the review process. Any deviation from the protocol 
will be described in the final report. 

The results of the search and selection process will be summarised in a PRISMA-ScR flowchart [27]. 

Data extraction 

Data extraction will be performed in Covidence, using pre-defined categories described in Annex 4. The data 
extraction form will be pilot tested using at least five publications, and adapted as necessary.  

One reviewer will independently extract data from selected publications and a second reviewer will screen 20% of 
the data extracted.  

Analysis of the evidence 

The review team will apply an iterative and deductive process to assess a priori categories (e.g. scope, type of data 
linkage, population and time horizon of the care cascade) and an inductive approach for post hoc considerations 
(e.g. reported study objectives and key findings). 

Basic characteristics of the evidence found will be summarised descriptively − e.g. distribution of the number and 
type of publications, year of publication, study designs and country of origin.  

A critical appraisal of the publications included (i.e. assessment of methodological considerations or risk of bias) 
will not be performed as this is a scoping review. 

Presentation of the results 

Results will be summarised in tables and diagrams aligned with the review questions. Narrative summaries will 
further describe the main findings.  

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TECHNICAL REPORT 

The cascade-of-care for tuberculosis infection in low-incidence countries – a scoping review protocol 

Knowledge user engagement 

For the purposes of the proposed scoping review, members of the EU/EEA TB Disease Network [35] were identified 
as the main knowledge users. The TB Disease Coordination Committee (an advisory group elected from members 
of the EU/EEA TB Disease Network) was consulted in the early stages of conceptualisation. 

After an initial list has been drawn up of the publications to be included TB Disease Network members will be 
involved in the identification of additional sources of evidence. In addition, they will be consulted about the 
relevance of preliminary results and dissemination channels for key findings. This collaborative process will be 
documented and included in the final report. 

Timeline 

The anticipated completion date of the scoping review is 1 December 2024. 

Table 2. Stages of the scoping review and timing 

Stage 

Time 

Started 

Completed 

Conceptualisation and initial design 
Explorative searches and definition of review 
questions 
Development of scoping review protocol 
Development of search strategy 
Running of literature searches 
Pilot testing of data extraction forms 
Assessment of eligibility  
Data extraction 
Data analysis 
Preparation of final report 

November 2022  
April − May 2023 

August 2023 − January 2024 
September − November 2023 
January 2024 
December 2023 − January 2024 
February − March 2024 
April − July  2024 
August – September 2024 
October − November 2024 

Yes 
Yes 

Yes 
Yes 
Yes 
Yes 
No 
No 
No 
No 

Yes 
Yes 

Yes 
Yes  
Yes 
No 
No 
No 
No 
No 

Review team 

Table 3. Review team members and their roles 

Members 

Conceptualisation 

Senia Rosales-Klintz* 
Ana-Belen Escriva 
Veronica Cristea 
Csaba Ködmön 

X 

X 
X 

Design of 
search 
strategy 

X 
X 

Contributions 

Overall study 
design 

X 

X 
X 

Drafting 
the 
protocol 

X 

Approved 
final version 

X 
X 
X 
X 

*Corresponding author (Senia.Rosales-Klintz@ecdc.europa.eu) 

Funding 

This review is being conducted by ECDC as part of its 2023−2024 routine TB activities. ECDC is the sole funder of 
this scoping review. The preparation of this protocol was conducted in the absence of any commercial or financial 
relationships that could be interpreted as a potential conflict of interest. 

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The cascade-of-care for tuberculosis infection in low-incidence countries – a scoping review protocol 

References 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

10. 

11. 

12. 

13. 

14. 

15. 

16. 

United Nations (UN). Goals: 3. Ensure healthy lives and promote well-being for all at all ages. New York: 
United Nations; 2024. Available at: https://sdgs.un.org/goals/goal3 

World Health Organization (WHO). Implementing the end TB strategy: the essentials, 2022 update. Geneva: 
WHO; 2022. Available at: https://www.who.int/publications/i/item/9789240065093 

World Health Organization (WHO). Towards tuberculosis elimination: an action framework in low-incidence 
countries. Geneva: WHO; 2014. Available at: https://www.who.int/publications/i/item/9789241507707 

World Health Organization (WHO). WHO consolidated guidelines on tuberculosis: tuberculosis preventive 
treatment. Geneva: WHO; 2020. Available at: https://tbksp.org/en/node/2 

World Health Organization (WHO). WHO operational handbook on tuberculosis. Module 1: prevention - 
tuberculosis preventive treatment. Geneva: WHO; 2020. Available at: https://tbksp.org/en/node/619 

Houben RM, Dodd PJ. The Global Burden of Latent Tuberculosis Infection: A Re-estimation Using 
Mathematical Modelling. PLoS Med. 2016 Oct;13(10):e1002152.  

Cohen A, Mathiasen VD, Schön T, Wejse C. The global prevalence of latent tuberculosis: a systematic 
review and meta-analysis. Eur Respir J. 2019 Sep;54(3)  

European Centre for Disease Prevention and Control (ECDC). Programmatic management of latent 
tuberculosis infection in the European Union. Stockholm: ECDC; 2018. Available at: 
http://dx.doi.org/10.2900/971917 

Alsdurf H, Hill PC, Matteelli A, Getahun H, Menzies D. The cascade of care in diagnosis and treatment of 
latent tuberculosis infection: a systematic review and meta-analysis. Lancet Infect Dis. 2016 
Nov;16(11):1269-78.  

Perlman DC, Jordan AE, Nash D. Conceptualizing Care Continua: Lessons from HIV, Hepatitis C Virus, 
Tuberculosis and Implications for the Development of Improved Care and Prevention Continua. Front Public 
Health. 2016;4:296.  

Subbaraman R, Nathavitharana RR, Mayer KH, Satyanarayana S, Chadha VK, Arinaminpathy N, et al. 
Constructing care cascades for active tuberculosis: A strategy for program monitoring and identifying gaps 
in quality of care. PLoS Med. 2019 Feb;16(2):e1002754.  

Teo AKJ, Morishita F, Prem K, Eng S, An Y, Huot CY, et al. Where are the missing people affected by 
tuberculosis? A programme review of patient-pathway and cascade of care to optimise tuberculosis case-
finding, treatment and prevention in Cambodia. BMJ Glob Health. 2023 Mar;8(3)  

Parriott A, Malekinejad M, Miller AP, Marks SM, Horvath H, Kahn JG. Care Cascade for targeted tuberculosis 
testing and linkage to Care in Homeless Populations in the United States: a meta-analysis. BMC Public 
Health. 2018 Apr 12;18(1):485.  

Bastos ML, Melnychuk L, Campbell JR, Oxlade O, Menzies D. The latent tuberculosis cascade-of-care among 
people living with HIV: A systematic review and meta-analysis. PLoS Med. 2021 Sep;18(9):e1003703.  

Campbell JI, Sandora TJ, Haberer JE. A scoping review of paediatric latent tuberculosis infection care 
cascades: initial steps are lacking. BMJ Glob Health. 2021 May;6(5)  

Rustage K, Lobe J, Hayward SE, Kristensen KL, Margineanu I, Stienstra Y, et al. Initiation and completion of 
treatment for latent tuberculosis infection in migrants globally: a systematic review and meta-analysis. 
Lancet Infect Dis. 2021 Dec;21(12):1701-12.  

17.  Medland NA, McMahon JH, Chow EP, Elliott JH, Hoy JF, Fairley CK. The HIV care cascade: a systematic 

review of data sources, methodology and comparability. J Int AIDS Soc. 2015;18(1):20634.  

18. 

Del Rosario A, Eldredge JD, Doorley S, Mishra SI, Kesler D, Page K. Hepatitis C virus care cascade in 
persons experiencing homelessness in the United States in the era of direct-acting antiviral agents: A 
scoping review. J Viral Hepat. 2021 Nov;28(11):1506-14.  

19.  Mugglin C, Kläger D, Gueler A, Vanobberghen F, Rice B, Egger M. The HIV care cascade in sub-Saharan 

Africa: systematic review of published criteria and definitions. J Int AIDS Soc. 2021 Jul;24(7):e25761.  

20. 

21. 

22. 

23. 

24. 

Page MJ, Shamseer L, Tricco AC. Registration of systematic reviews in PROSPERO: 30,000 records and 
counting. Syst Rev. 2018 Feb 20;7(1):32.  

Foster ED, Deardorff A. Open Science Framework (OSF). J Med Libr Assoc. 2017 Apr;105(2):203-6.  

Figshare [repository]. Cambridge, MA.: Digital Science; 2024. Available at: https://figshare.com/ 

Pollock D, Peters MDJ, Khalil H, McInerney P, Alexander L, Tricco AC, et al. Recommendations for the extraction, 
analysis, and presentation of results in scoping reviews. JBI Evid Synth. 2023 Mar 1;21(3):520-32.  

Peters MDJ, Godfrey C, McInerney P, Khalil H, Larsen P, Marnie C, et al. Best practice guidance and 
reporting items for the development of scoping review protocols. JBI Evid Synth. 2022 Apr 1;20(4):953-68.  

6 

 
 
 
 
 
 
TECHNICAL REPORT 

The cascade-of-care for tuberculosis infection in low-incidence countries – a scoping review protocol 

25. 

26. 

27. 

28. 

Joanna Briggs Institute (JBI). 11.2 Development of a scoping review protocol. 2020. In: Aromataris E, Munn 
Z, editors. JBI Manual for Evidence Synthesis. Adelaide, Australia: JBI. Available at: 
https://wiki.jbi.global/display/MANUAL/11.2+Development+of+a+scoping+review+protocol 

Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the 
conduct of scoping reviews. JBI Evidence Synthesis. 2020;18(10):2119-26. Available at: 
https://journals.lww.com/jbisrir/Fulltext/2020/10000/Updated_methodological_guidance_for_the_conduct_of.4.aspx 

Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews 
(PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018 Oct 2;169(7):467-73.  

Staniszewska S, Brett J, Simera I, Seers K, Mockford C, Goodlad S, et al. GRIPP2 reporting checklists: tools 
to improve reporting of patient and public involvement in research. Bmj. 2017 Aug 2;358:j3453.  

29.  Migliori GB, Wu SJ, Matteelli A, Zenner D, Goletti D, Ahmedov S, et al. Clinical standards for the diagnosis, 

treatment and prevention of TB infection. Int J Tuberc Lung Dis. 2022 Mar 1;26(3):190-205.  

30. 

Haber N, Pillay D, Porter K, Bärnighausen T. Constructing the cascade of HIV care: methods for 
measurement. Curr Opin HIV AIDS. 2016 Jan;11(1):102-8.  

31.  McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS Peer Review of Electronic 
Search Strategies: 2015 Guideline Statement. Journal of Clinical Epidemiology. 2016 2016/07/01/;75:40-6. 
Available at: https://www.sciencedirect.com/science/article/pii/S0895435616000585 

32. 

33. 

34. 

35. 

Haddaway NR, Grainger MJ, Gray CT. Citationchaser: A tool for transparent and efficient forward and 
backward citation chasing in systematic searching. Res Synth Methods. 2022 Jul;13(4):533-45.  

Van de Schoot R, de Bruin J, Schram R, Zahedi P, de Boer J, Weijdema F, et al. An open source machine 
learning framework for efficient and transparent systematic reviews. Nature Machine Intelligence. 2021 
2021/02/01;3(2):125-33. Available at: https://doi.org/10.1038/s42256-020-00287-7 

Van Dijk SHB, Brusse-Keizer MGJ, Bucsán CC, van der Palen J, Doggen CJM, Lenferink A. Artificial 
intelligence in systematic reviews: promising when appropriately used. BMJ Open. 2023 Jul 
7;13(7):e072254.  

European Centre for Disease Prevention and Control (ECDC). Tuberculosis Disease Network. Stockholm: 
ECDC; 2024. Available at: https://www.ecdc.europa.eu/en/about-us/partnerships-and-networks/disease-
and-laboratory-networks/tuberculosis-disease-network 

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applicable 
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TECHNICAL REPORT 

The cascade-of-care for tuberculosis infection in low-incidence countries – a scoping review protocol 

Annex 1. Checklist of recommended items to 
address in a scoping review protocol 

Section 

Item 

Checklist item 

Title 

Identification 
Update 

1a 
1b 

Identify the report as a protocol of a scoping review. 
If the protocol is for an update of a previous scoping review, identify 
it as such. 

Registration 

2 

If registered, provide the name of the registry and registration 
number. 

Authors 

Contact 

Contributions 

3a 

3b 

Amendments 

4 

Support 

Sources 
Sponsor 
Role of sponsor 
or funder 

Introduction 

Rationale 

Objectives 

Methods 

5a 
5b 
5c 

6 

7 

Provide name, institutional affiliation, email address of all protocol 
authors; provide physical mailing address of corresponding author. 
Describe contributions of protocol authors and identify the guarantor 
of the review. 
If the protocol represents an amendment of a previously completed 
or published protocol, identify as such and list changes. Otherwise, 
state plan for documenting important protocol amendments. 

Indicate the sources of financial or other support for the review. 
Provide name of the review funder and/or sponsor. 
Describe roles of funder(s), sponsor(s), and/or institution(s), if any, in 
developing the protocol. 

Describe the rationale for the review in the context of what is already 
known. (Note: consider providing a rationale for the decision to 
conduct a scoping review rather than other evidence synthesis 
approaches). 
Provide an explicit statement of the question(s) that the review will 
address, with reference to the inclusion and exclusion criteria. 

5 
5 
5 

1 

2 

Eligibility criteria  8 

Information 
sources* 

9 

Specify characteristics of the sources of evidence to be used as eligibility 
criteria (e.g. years considered, language, and publication status). 

Describe all intended information sources (e.g. databases, contact 
with authors, trial registers or other grey literature sources) with 
planned dates of coverage. 

Search strategy 

10 

Present draft of search strategy to be used for at least one database, 
including any limits used, so that it could be repeated. 

Data 
management  

Selection 
process 

Data collection 
process 

Data items 

Outcomes and 
prioritisation 

11a 

11b 

11c 

12 

13 

Describe the mechanism(s) that will be used to manage records and 
data throughout the review. 
State the process that will be used for selecting sources of evidence† 
(such as two independent reviewers) through each phase of the 
review (i.e. screening, eligibility, and inclusion). 

Describe the planned methods for extracting data from reports (such 
as piloting forms, completed independently, in duplicate), and any 
processes for obtaining and confirming data from investigators. 

List and define all variables for which data will be sought, any 
preplanned data assumptions and simplifications made. 

List and define all outcomes for which data will be sought, including 
prioritisation of main and additional outcomes, with rationale (Note: 
scoping reviews may not extract outcome data, so this can refer to 
whichever data items are extracted). 

2-3 and 13-
14 (Annex 3) 
3 

3 and 10-12 
(Annex 2) 
4 

4 

4 

15 (Annex 4) 

Not 
applicable 

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The cascade-of-care for tuberculosis infection in low-incidence countries – a scoping review protocol 

Section 

Item 

Checklist item 

Risk of bias in 
individual 
studies 

14 

Data synthesis  

15a 

If this is to occur, describe anticipated methods for assessing the risk 
of bias of individual studies, including whether this will be done at the 
outcome, study level, or both. State how this information will be used 
in data synthesis (Note: scoping reviews typically do not include risk 
of bias assessment, but this information should be described if there 
will be a risk). 

Describe criteria under which study data will be presented (Note: 
scoping reviews do not typically include quantitative synthesis of 
study data, but should still describe in advance how it is anticipated 
that extracted data will be presented in the resulting review). 

15b 

15c 

Describe the planned approach to how extracted data will be 
presented (such as figures, tables, evidence gap maps). 

Describe any proposed additional analyses (such as thematic 
analyses). (Note: the JBI methodological guidance does not 
recommend undertaking thematic analysis as the data synthesis 
should ideally occur following methodological appraisal of the 
included sources). 

15d 

If quantitative synthesis is not appropriate, describe the type of 
summary planned. 

Meta-bias (es) 

16 

Specify any planned assessment of meta-bias(es) (such as publication 
bias across studies, selective reporting within studies). (Note: scoping 
reviews typically do not include assessment of meta-bias, but if there 
will be bias, this information should be described). 

Reported 
on page # 
Not 
applicable 

4 

4 

Not 
applicable 

Not 
applicable 

Not 
applicable 

Confidence in 
cumulative 
evidence 

20 

Describe how the strength of the body of evidence will be assessed 
(such as GRADE). 

Not 
applicable 

* Where ‘sources of evidence’ (see second footnote) are compiled from, such as bibliographic databases, social media platforms, 
and websites. 

† A more inclusive/heterogeneous term used to account for the different types of evidence or data sources (e.g. quantitative 
and/or qualitative research, expert opinion, and policy documents) that may be eligible in a scoping review, as opposed to only 
studies. This should not be confused with information sources (see first footnote). 

Adapted from [24, 27]. 

9 

 
 
 
 
 
 
 
 
TECHNICAL REPORT 

The cascade-of-care for tuberculosis infection in low-incidence countries – a scoping review protocol 

Annex 2. Draft search strategy 

No. 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

PubMed search string 

"latent tuberculosis"[MeSH] OR latent tuberculosis[TW] OR latent TB[TW] OR LTBI[TW] OR "latent 
tuberculosis"[Title/Abstract:~5] OR "latent TB"[Title/Abstract:~5] OR tuberculosis infect*[TW] OR TB infect*[TW] OR 
"TB infection"[Title/Abstract:~1] OR "TB infections"[Title/Abstract:~1] OR "TB infected"[Title/Abstract:~1] OR "TB 
infecting"[Title/Abstract:~1] OR "TB infectious"[Title/Abstract:~1] OR "TB infectiousness"[Title/Abstract:~1] OR 
"tuberculosis infection"[Title/Abstract:~1] OR "tuberculosis infections"[Title/Abstract:~1] OR "tuberculosis 
infected"[Title/Abstract:~1] OR "tuberculosis infecting"[Title/Abstract:~1] OR "tuberculosis 
infectious"[Title/Abstract:~1] OR "tuberculosis infectiousness"[Title/Abstract:~1] 

"Tuberculin Test"[Title/Abstract:~1] OR "Tuberculin Tests"[Title/Abstract:~1] OR "Tuberculin 
Testing"[Title/Abstract:~1] OR "Tuberculin Tested"[Title/Abstract:~1] 

#1 AND #2 

"interferon-gamma release tests"[Mesh] OR "interferon gamma release test*"[TW] OR "interferon gamma release 
assay*"[TW] OR igra[TW] 
#1 AND #4 

Treatment adheren*[TW] OR treatment complian*[TW] OR treatment complet*[TW] OR "treatment 
comply"[Title/Abstract:~3] OR "treatment adhere"[Title/Abstract:~3] OR "treatment adherence"[Title/Abstract:~3] OR 
"treatment compliance"[Title/Abstract:~3] OR "treatment compliant"[Title/Abstract:~3] OR "treatment 
completion"[Title/Abstract:~3] OR "treatment complete"[Title/Abstract:~3] OR "treatment 
completed"[Title/Abstract:~3] 
#1 AND #6 

"Contact Tracing"[Mesh] OR contact trac*[TW] OR "contact tracing"[Title/abstract:~3] OR "contact 
trace"[Title/abstract:~3] OR "contact traces"[Title/abstract:~3] OR "contact tracers"[Title/abstract:~3] OR "contact 
tracking"[Title/abstract:~3] OR contact investigat*[TW] OR "contact investigation"[Title/abstract:~3] OR "contact 
investigators"[Title/abstract:~3] 
#1 AND #8 

preventive treat*[TW] OR "preventive treatment"[Title/abstract:~3] OR "preventive treatments"[Title/abstract:~3] OR 
preventive therap*[TW] OR "preventive therapy"[Title/abstract:~3] OR "preventive therapeutic"[Title/abstract:~3] OR 
"preventive therapeutics"[Title/abstract:~3] 

#1 AND #10 

#3 OR #5 OR #7 OR #9 OR #11 

"latent tuberculosis"[MeSH] OR latent tuberculosis[TW] OR latent TB[TW] OR LTBI[TW] OR "latent 
tuberculosis"[Title/Abstract:~10] OR "latent TB"[Title/Abstract:~10] OR tuberculosis infect*[TW] OR TB infect*[TW] 
OR "TB infection"[Title/Abstract:~10] OR "TB infections"[Title/Abstract:~10] OR "TB infected"[Title/Abstract:~10] OR 
"TB infecting"[Title/Abstract:~10] OR "TB infectious"[Title/Abstract:~10] OR "TB infectiousness"[Title/Abstract:~10] 
OR "TB infections"[Title/Abstract:~10] OR "tuberculosis infection"[Title/Abstract:~10] OR "tuberculosis 
infections"[Title/Abstract:~10] OR "tuberculosis infected"[Title/Abstract:~10] OR "tuberculosis 
infecting"[Title/Abstract:~10] OR "tuberculosis infectious"[Title/Abstract:~10] OR "tuberculosis 
infectiousness"[Title/Abstract:~10] OR "tuberculosis infections"[Title/Abstract:~10] 
"treatment cascade"[Title/Abstract:~10] OR "care cascade"[Title/Abstract:~10] OR "diagnostic 
cascade"[Title/Abstract:~10] OR "treatment cascades"[Title/Abstract:~10] OR "care cascades"[Title/Abstract:~10] OR 
"diagnostic cascades"[Title/Abstract:~10] OR "treatment cascading"[Title/Abstract:~10] OR "care 
cascading"[Title/Abstract:~10] OR "diagnostic cascading"[Title/Abstract:~10] OR "treatment 
cascaded"[Title/Abstract:~10] OR "care cascaded"[Title/Abstract:~10] OR "diagnostic cascaded"[Title/Abstract:~10] 
OR "continuum care"[Title/Abstract:~10] OR "linkage care"[Title/Abstract:~10] OR "care 
continuity"[Title/Abstract:~10] OR "care continuation"[Title/Abstract:~10] OR "care continuous"[Title/Abstract:~10] 
OR "care continua"[Title/Abstract:~10] OR "care continuums"[Title/Abstract:~10] OR care cascad*[TW] OR "cascades 
of care"[TW] OR "cascade of care"[TW] OR continuum of care*[TW] OR continuum care*[TW] OR linkage to 
care*[TW] OR care continu*[TW] OR "Continuity of Patient Care"[Mesh] 
((cascad*[TI] OR continu*[TI] OR linkag*[TI]) AND care*[TI]) 

(treat*[TI] OR diagnos*[TI]) AND cascad*[TI] 

#14 OR #15 OR #16 

#13 AND #17 

#12 OR #18 

#19 AND 1990:2024[dp] 

10 

 
 
 
 
 
 
 
 
TECHNICAL REPORT 

The cascade-of-care for tuberculosis infection in low-incidence countries – a scoping review protocol 

No. 

#1 

#2 

#3 

#4 

#5 

#6 

#7 
#8 

#9 

#10 

#11 

#12 

#13 

#14 

#15 

#16 

#17 

#18 

#19 

#20 

#21 

#22 

#23 

#24 

#25 

#26 

#27 

Embase search string 

ltbi:ab,ti,kw 

(latent NEAR/5 (tuberculosis OR tb)):ab,ti,kw 

(infect* NEAR/1 (tuberculosis OR tb)):ab,ti,kw 

#1 OR #2 OR #3 

(tuberculin NEAR/1 test*):ab,ti,kw 

#4 AND #5 

'interferon gamma release test*':ab,ti,kw OR 'interferon gamma release assay*':ab,ti,kw OR igra:ab,ti,kw 
#4 AND #7 

(treatment* NEAR/3 (adhere OR comply OR adheren* OR complian* OR complet*)):ab,ti,kw 

#4 AND #9 

(contact NEAR/3 (trac* OR investigat*)):ab,ti,kw 

#4 AND #11 

(prevent* NEAR/3 (treat* OR therap*)):ab,ti,kw 

#4 AND #13 

#6 OR #8 OR #10 OR #12 OR #14 

(latent NEAR/10 (tuberculosis OR tb)):ab,ti,kw 

(infect* NEAR/10 (tuberculosis OR tb)):ab,ti,kw 

#1 OR #16 OR #17 

'cascade of care'/syn 

((treat* OR diagnos* OR care*) NEAR/10 cascad*):ab,ti,kw 

((continu* OR linkag*) NEAR/10 care*):ab,ti,kw 

(cascad*:ti OR continu*:ti OR linkag*:ti) AND care*:ti 

(treat*:ti OR diagnos*:ti) AND cascad*:ti 

#19 OR #20 OR #21 OR #22 OR #23 

#18 AND #24 

#15 OR #25 

#26 AND [1990-2024]/py 

11 

 
 
 
 
 
 
 
 
 
TECHNICAL REPORT 

The cascade-of-care for tuberculosis infection in low-incidence countries – a scoping review protocol 

No. 

#1 

#2 

#3 

#4 

#5 

#6 

#7 

#8 

#9 

#10 

#11 

#12 

#13 

#14 

#15 

#16 

#17 

#18 

#19 

#20 

#21 

#22 

#23 

#24 

#25 

#26 

Scopus search string 

TITLE-ABS(ltbi) 

TITLE-ABS(latent W/5 (tuberculosis OR tb))  

TITLE-ABS(infect* W/1 (tuberculosis OR tb)) 

#1 OR #2 OR #3 

TITLE-ABS(tuberculin W/1 test*) 

#4 AND #5 

TITLE-ABS("interferon gamma release test*" OR "interferon gamma release assay*" OR igra) 

#4 AND #7 

TITLE-ABS(treatment* W/3 (adhere OR comply OR adheren* OR complian* OR complet*)) 

#4 AND #9 

TITLE-ABS(contact W/3 (trac* OR investigat*)) 

#4 AND #11 

TITLE-ABS(prevent* W/3 (treat* OR therap*)) 

#4 AND #13 

#6 OR #8 OR #10 OR #12 OR #14 

TITLE-ABS(latent W/10 (tuberculosis OR tb)) 

TITLE-ABS(infect* W/10 (tuberculosis OR tb)) 

#1 OR #16 OR #17 

TITLE-ABS((treat* OR diagnos* OR care*) W/10 cascad*) 

TITLE-ABS((continu* OR linkag*) W/10 care*) 

TITLE(cascad* OR continu* OR linkag*) AND TITLE(care*) 

TITLE(treat* OR diagnos*) AND TITLE(cascad*) 

#19 OR #20 OR #21 OR #22 

#18 AND #23 

#15 OR #24 

#25 AND PUBYEAR AFT 1989 

12 

 
 
 
 
 
 
 
 
TECHNICAL REPORT 

The cascade-of-care for tuberculosis infection in low-incidence countries – a scoping review protocol 

Annex 3. Checklists for inclusion and 
exclusion criteria 

Title/abstract screening 

Criteria for inclusion (all must be present) 

1. The publication relates to TB infection. 

Yes /No 

2. The publication reports on human populations (irrespective of age). 

3. The publication reports primary data from a low-TB incidence country/countries. 

Criteria for inclusion (all must be present) 

Yes/No 

Full text screening 

1. The publication reports on at least two consecutive steps of the cascade-of-care for TB infection 

(described in Figure A below). 

2. The publication reports on primary data from one (or more) low-TB incidence country. 

3.  Primary studies (both peer-reviewed and grey literature) with any of the following study designs: 
observational studies (cohort and cross-sectional), randomised control trials, qualitative studies, 
systematic reviews and scoping reviews. 

Criteria for exclusion (any of these justify exclusion) 

1. Editorials, commentaries, case reports and earlier versions of a publication (e.g. pre-prints or 

conference abstracts of a final peer-reviewed article). 

2. The publication focuses on diagnostic accuracy of screening tests for TB infection. 

3. The publication focuses on efficacy of TB preventive treatment regimens. 

4. The publication focuses on cost-effectiveness analyses. 

5. Full-text not available for screening. 

13 

 
 
 
 
 
 
 
 
 
 
  
  
 
 
 
 
 
 
 
 
 
 
TECHNICAL REPORT 

The cascade-of-care for tuberculosis infection in low-incidence countries – a scoping review protocol 

Figure 1. TB infection cascade-of-care process 

Total identified 

With risk factors for TB 
infection or disease 

Tested for 
TB infection 

Received 
(positive) 
test results 

Referred for medical 
evaluation (to rule out 
active TB) 

Completed medical 
evaluation  

Offered TB preventive 
treatment (TPT)  

Started TPT 

Completed TPT  

14 

 
 
 
 
 
 
 
 
 
 
TECHNICAL REPORT 

The cascade-of-care for tuberculosis infection in low-incidence countries – a scoping review protocol 

Annex 4. Data extraction variables  

Concept 

Variables 

General information 

Population 

Cascade-of-care  

TB infection 

TB preventive treatment 

Context 

Key findings 

Number of study participants 
Type of population (by age) 
Type of population (by risk factors/comorbidities).  

Reference ID number 
Author 
Year of publication 
Publication status (published/unpublished) 
Country 
Aim of the study 
Study design 
Period of data collection (if applicable). 

• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
Data sources used (as reported by the authors) 
• 
Steps of the cascade-of care reported by the authors 
• 
Definition of numerator and denominator used in each step, as reported by the authors. 
•  Methods used for constructing the cascade-of-care analysis (as reported by the authors) 
• 
• 
• 
• 
• 
• 
Criteria used for assessing eligibility (e.g. positive test result or risk factor) 
• 
TB preventive treatment regimen indicated (as reported by the authors) 
• 
Adherence support approaches (as reported by the authors, if any) 
•  Monitoring of adverse events (as reported by the authors, if any). 
• 
• 
• 
• 
• 

Type of data linkage 
Type of population base (single or multiple) 
Time horizon ( longitudinal or cross-sectional) 
Type of indicators used (as reported by the authors, if any). 

Key findings or main conclusion(s) (as reported by the authors) 
Challenges, if applicable (as reported by the authors) 
Lessons learned, if applicable (as reported by the authors). 

Type of healthcare setting (primary, secondary or tertiary level) 
Jurisdiction (local, regional or national). 

Screening methods used for diagnosing TB infection (if any). 

15