ArticlePloS one2017
A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 3 of them syntheses that pooled it.
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Who cites it
27 citing papers in PubMed, 3 syntheses or guidelines pooled it, 68 citations in OpenAlex.
- Clinical utility of WHO-recommended screening tools and development and validation of novel clinical prediction models for pulmonary tuberculosis screening among outpatients living with HIV: an individual participant data meta-analysis.European respiratory review : an official journal of the European Respiratory Society · 2023Pooled it
- Tuberculosis screening among ambulatory people living with HIV: a systematic review and individual participant data meta-analysis.The Lancet. Infectious diseases · 2022Pooled it
- Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults.The Cochrane database of systematic reviews · 2021Pooled it
- Literature Review on HIV-Viruses · 2026Review
- Frequency of tuberculosis symptoms at repeat visits amongst adults attending for HIV care in Gauteng province, South Africa.BMC public health · 2025Article
- A clinical scoring system to predict tuberculous lymphadenitis in settings with high disease burden.Scientific reports · 2025Article
- Article
- Development and validation of the Tuberculosis Diabetes Mellitus-Predictive Tool (TBDM-PT) in primary care.Malaysian family physician : the official journal of the Academy of Family Physicians of Malaysia · 2025Article
- Cost-effectiveness analysis of a prediction model for community-based screening of active tuberculosis.Journal of global health · 2024Article
- LSTM-Based Prediction Model for Tuberculosis Among HIV-Infected Patients Using Structured Electronic Medical Records: A Retrospective Machine Learning Study.Journal of multidisciplinary healthcare · 2024Article
- Predictors contributing to the estimation of pulmonary tuberculosis among adults in a resource-limited setting: A systematic review of diagnostic predictions.SAGE open medicine · 2024Review
- Development and validation of a risk prediction model for pulmonary tuberculosis among presumptive tuberculosis cases in Ethiopia.BMJ open · 2023Article
- Development and Validation of the Tuberculosis Risk Score for Smokers (TBRSS).International journal of environmental research and public health · 2022Article
- Machine learning-based in-hospital mortality prediction of HIV/AIDS patients with Talaromyces marneffei infection in Guangxi, China.PLoS neglected tropical diseases · 2022Article
- Predicting the risk of active pulmonary tuberculosis in people living with HIV: development and validation of a nomogram.BMC infectious diseases · 2022Article
- Clinical predictors of pulmonary tuberculosis among South African adults with HIV.EClinicalMedicine · 2022Article
- Predictors of tuberculosis disease in smokers: a case-control study in northeastern Malaysia.PeerJ · 2022Article
- Derivation and external validation of a risk score for predicting HIV-associated tuberculosis to support case finding and preventive therapy scale-up: A cohort study.PLoS medicine · 2021Article
- Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort.Medical mycology · 2021Article
- Informing Balanced Investment in Services and Health Systems: A Case Study of Priority Setting for Tuberculosis Interventions in South Africa.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2020Article
Corrections and comments
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Authors and funding
16 authors at 7 institutions in 2 countries.
Funding
Abstract
backgroundThe World Health Organization (WHO) recommendation for regular tuberculosis (TB) screening of HIV-positive individuals with Xpert MTB/RIF as the first diagnostic test has major resource implications.
objectiveTo develop a diagnostic prediction model for TB, for symptomatic adults attending for routine HIV care, to prioritise TB investigation.
designCohort study exploring a TB testing algorithm.
settingHIV clinics, South Africa.
participantsRepresentative sample of adult HIV clinic attendees; data from participants reporting ≥1 symptom on the WHO screening tool were split 50:50 to derive, then internally validate, a prediction model. OUTCOME: TB, defined as "confirmed" if Xpert MTB/RIF, line probe assay or M. tuberculosis culture were positive; and "clinical" if TB treatment started without microbiological confirmation, within six months of enrolment.
resultsOverall, 79/2602 (3.0%) participants on ART fulfilled TB case definitions, compared to 65/906 (7.2%) pre-ART. Among 1133/3508 (32.3%) participants screening positive on the WHO tool, 1048 met inclusion criteria for this analysis: 52/515 (10.1%) in the derivation and 58/533 (10.9%) in the validation dataset had TB. Our final model comprised ART status (on ART > 3 months vs. pre-ART or ART < 3 months); body mass index (continuous); CD4 (continuous); number of WHO symptoms (1 vs. >1 symptom). We converted this to a clinical score, using clinically-relevant CD4 and BMI categories. A cut-off score of ≥3 identified those with TB with sensitivity and specificity of 91.8% and 34.3% respectively. If investigation was prioritised for individuals with score of ≥3, 68% (717/1048) symptomatic individuals would be tested, among whom the prevalence of TB would be 14.1% (101/717); 32% (331/1048) of tests would be avoided, but 3% (9/331) with TB would be missed amongst those not tested.
conclusionOur clinical score may help prioritise TB investigation among symptomatic individuals.
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