Observational studyBMJ open2022
Optimising Xpert-Ultra and culture testing to reliably measure tuberculosis prevalence in the community: findings from surveys in Zambia and South Africa.
Observational study in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03739736 (Tuberculosis Reduction Through Expanded Anti-retroviral Therapy and Screening of Active TB Project), which is not on this map. Cited by 22 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Tuberculosis Reduction Through Expanded Anti-retroviral Therapy and Screening of Active TB Project
Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- Diagnostic accuracy of Xpert MTB/RIF Ultra for detecting pulmonary tuberculosis and rifampicin resistance: a systematic review and meta-analysis.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2025Pooled it
- Trial
- Prevalence and Predictors of Tuberculosis in Adults and Adolescents With Sputum Trace Ultra Results in 2 High-Burden Clinical Settings.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Long-term risk of tuberculosis among individuals with Xpert Ultra trace screening results in Uganda: a longitudinal follow-up study.The Lancet. Infectious diseases · 2026Article
- Evaluation of stool-based testing to diagnose tuberculosis in children using the Truenat platform in routine settings in Nigeria.Journal of clinical microbiology · 2026Article
- Bridging the analog divide: a comparison of printed X-ray films and digital images when using computer-aided detection software for tuberculosis screening.BMC global and public health · 2026Article
- An Uncommon Case of Recurring Pulmonary, Lymphatic, and Skeletal Tuberculosis Accompanied by Myositis: Is It Associated with Particular Resistance?International medical case reports journal · 2026Article
- Accuracy and operational performance of computer-aided detection software use cases for TB screening: a retrospective comparative evaluation in Ho Chi Minh City, Viet Nam.BMJ public health · 2026Article
- Quantifying excess TB prevalence among people living with HIV on ART in the universal ART era: Evidence from a TB prevalence survey in Zambia and South Africa.PLOS global public health · 2026Article
- Importance of confirmatory test characteristics in optimizing community-based screening for tuberculosis: an epidemiological modeling analysis.BMC infectious diseases · 2025Article
- Do no harm - re-evaluating the risks of overtreatment in community-wide tuberculosis screening.medRxiv : the preprint server for health sciences · 2025Article
- Patient experiences of tuberculosis treatment deferral after a trace Xpert Ultra result: a prospective cohort study.Infectious diseases of poverty · 2025Article
- Incremental yield in detection of TB by testing multiple stool specimens from one person.IJTLD open · 2025Article
- Persistently high TB prevalence in Nairobi County neighbourhoods, 2015-2022.PLOS global public health · 2025Article
- Clinical outcomes of participants of a TB prevalence survey with an abnormal chest X-ray but no evidence of TB disease after a median follow-up of 9 months in Zambia and South Africa.PLOS global public health · 2025Article
- Evidence for Tuberculosis in Individuals With Xpert Ultra "Trace" Sputum During Screening of High-Burden Communities.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Comparing patterns of recent and remote Mycobacterium tuberculosis infection determined using the QuantiFERON-TB Gold Plus assay in a high TB burden setting.PLOS global public health · 2024Article
- Computer-aided detection thresholds for digital chest radiography interpretation in tuberculosis diagnostic algorithms.ERJ open research · 2024Article
- Article
- The application of metagenomic next-generation sequencing in pathogen diagnosis: a bibliometric analysis based on Web of Science.Frontiers in cellular and infection microbiology · 2023Review
Corrections and comments
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Authors and funding
19 authors at 6 institutions in 4 countries.
Funding
Abstract
objectivesPrevalence surveys remain the best way to assess the national tuberculosis (TB) burden in many countries. Challenges with using culture (the reference standard) for TB diagnosis in prevalence surveys have led to increasing use of molecular tests (Xpert assays), but discordance between these two tests has created problems for deciding which individuals have TB. We aimed to design an accurate diagnostic algorithm for TB prevalence surveys (TBPS) that limits the use of culture.
designTBPS in four communities, conducted during 2019.
settingThree Zambian communities and one South-African community included in the TBPS of the Tuberculosis Reduction through Expanded Anti-retroviral Treatment and Screening study.
participantsRandomly sampled individuals aged ≥15 years. Among those who screened positive on chest X-ray or symptoms, two sputum samples were collected for field Xpert-Ultra testing and a third for laboratory liquid-culture testing. Clinicians reviewed screening and test results; in Zambia, participants with OUTCOMES: Culture and Xpert-Ultra test results.
resultsAmong 946 culture-negative individuals, 917 were Xpert-negative, 12 Xpert-trace-positive and 17 Xpert-positive (grade very low, low, medium or high), with Xpert categorised as the highest grade of the two sample results. Among 63 culture-positive individuals, 8 were Xpert-negative, 9 Xpert-trace-positive and 46 Xpert-positive. Counting trace-positive results as positive, the sensitivity of Xpert-Ultra compared with culture was 87% (95% CI 76% to 94%) using two samples compared with 76% (95% CI 64% to 86%) using one. Specificity was 97% when trace-positive results were counted as positive and 98% when trace-positive results were counted as negative. Most Xpert-Ultra-positive/culture-negative discordance was among individuals whose Xpert-positive results were trace-positive or very low grade or they reported previous TB treatment. Among individuals with both Xpert-Ultra results grade low or above, the positive-predictive-value was 90% (27/30); 3/30 were plausibly false-negative culture results.
conclusionUsing Xpert-Ultra as the primary diagnostic test in TBPS, with culture only for confirmatory testing, would identify a high proportion of TB cases while massively reducing survey culture requirements. TRIAL REGISTRATION NUMBER: NCT03739736.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.