Don’t forget about “irrelevant positives”!

I’m not convinced they are unimportant positives either…. U just thing we have absolutely no idea either way! And that seems a bit rash for TB peeps (not you particularly… but the general vibes) to be pushing ACF until we know. There will be individual harms too.

Yea, agree with all that. But I remain very irritated with all the “excitement” about community based screening DESPITE the fact that there is poor evidence on the individual level benefits and harms of detecting asymp. TB.

But what about “unimportant positives”? I mean, once you have a positive test you are obviously going to treat. But what would have happened to those people who never encountered screening for their (“true”) asymptomatic TB? How many would have reverted anyway and had no harm from their TB?

How did you not know that?! It’s a core ID fact!

Its right there in the title.

Gelman, Andrew, and Hal Stern. "The difference between “significant” and “not significant” is not itself statistically significant." The American Statistician 60, no. 4 (2006): 328-331.

sites.stat.columbia.edu/gelman/resea...

Well, any group can have individual douche bags in it. I feel like overall the Quakers are extremely awesome (doi: not a Quaker, but family are).

I’d quite like to know when to start ART in serum CrAg pos / CSF CrAg negative, relatively asymptomatic people though?

Yea, I think it depends what setting you are in and what you are trying to achieve? Biological betterness? Or less cost to people / easier to implement protocols? If you’ve got individualised care, different patients/scenarios are different. For one-size-fits-most policy I’m not sure it’s priority.

There is also a JIAS systematic review of SaPIT and all the other eight trials of earlier vs later TB kicking around (you may recognise some authors 🤣)…. The trials are a bit of a mixed bag.

I mean… Malawi have been starting ART and TB treatment on the same day (as diagnosis, and each other, without steroids) for a few years now. Seems to be fine for most people.

We’ve just finished a trial of same day vs deferred ART (“ART first” vs “TB results first”) in people with TB symptoms. Results in to IAS! But there was v little IRIS seen.

I love this! And so many GREAT people, looking at the names.

@theunion-tblh.bsky.social
@joylawn.bsky.social
@tb-lshtm.bsky.social
@thelancet.bsky.social

Aww, thank you!! And thank you for your FANTASTIC Stephen Lawn Lecture 2023 on the "know-do" gap. It was brilliant.