Evidence map›Paper›PMID 35963826›Full record

Trial reportTransactions of the Royal Society of Tropical Medicine and Hygiene2023

Utility of Xpert MTB/RIF Ultra and digital chest radiography for the diagnosis and treatment of TB in people living with HIV: a randomised controlled trial (XACT-TB).

Madalo Mukoka, Hussein H Twabi, Chisomo Msefula, Robina Semphere, Gabriel Ndhlovu, Trancizeo Lipenga, Tionge Daston Sikwese, Kenneth Malisita, Augustine Choko, Elizabeth L Corbett and 2 more

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Transactions of the Royal Society of Tropical Medicine and Hygiene, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 4 pooled it
2.0field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 4 syntheses or guidelines pooled it, 9 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. 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 · 2025
    Pooled it
  4. Pooled it
  5. Trial
  6. Article
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 4 institutions in 2 countries.

Madalo MukokaPathology Department, Helse Nord TB Initiative, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi.
Hussein H TwabiPathology Department, Helse Nord TB Initiative, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi.
Chisomo MsefulaPathology Department, Helse Nord TB Initiative, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi.
Robina SempherePathology Department, Helse Nord TB Initiative, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi.
Gabriel NdhlovuPathology Department, Helse Nord TB Initiative, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi.
Trancizeo LipengaPathology Department, Helse Nord TB Initiative, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi.
Tionge Daston SikwesePathology Department, Helse Nord TB Initiative, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi.
Kenneth MalisitaLighthouse Umodzi centre, Queen Elizabeth Central Hospital, P.O. Box 95, Blantyre, Malawi.
Augustine ChokoPublic Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, P.O. Box 30096, Blantyre, Malawi.
Elizabeth L CorbettPublic Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, P.O. Box 30096, Blantyre, Malawi.
Peter MacPhersonPublic Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, P.O. Box 30096, Blantyre, Malawi.ORCID 0000-0002-0329-9613
Marriott NliwasaPathology Department, Helse Nord TB Initiative, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi.
University of Liverpool · GBKamuzu Central Hospital · MWQueen Elizabeth Central Hospital · MWUniversity of London · GB

Funding

Wellcome TrustWellcome Trust 206575/Z/17/Z
6 · The paper itself

Abstract

backgroundTB is a leading cause of morbidity among HIV positive individuals. Accurate algorithms are needed to achieve early TB diagnosis and treatment. We investigated the use of Xpert MTB/RIF Ultra in combination with chest radiography for TB diagnosis in ambulatory HIV positive individuals.

methodsThis was a randomised controlled trial with a 2-by-2 factorial design. Outpatient HIV clinic attendees with cough were randomised to four arms: Arm 1-Standard Xpert/no chest radiography (CXR); Arm 2-Standard Xpert/CXR; Arm 3-Xpert Ultra/no CXR; and Arm 4-Xpert Ultra/CXR. Participants were followed up at days 28 and 56 to assess for TB treatment initiation.

resultsWe randomised 640 participants. Bacteriologically confirmed TB treatment initiation at day 28 were: Arm 1 (8.4% [14/162]), Arm 2 (6.9% [11/159]), Arm 3 (8.2% [13/159]) and Arm 4 (5.6% [9/160]) and between Xpert Ultra group (Arms 3 and 4) (6.9% [22/319]) vs Standard Xpert group (Arms 1 and 2) (7.8% [25/321]), risk ratio 0.89 (95% CI 0.51 to 1.54). By day 56, there were also similar all-TB treatment initiations in the x-ray group (Arms 2 and 4) (16.0% [51/319]) compared with the no x-ray group (Arms 1 and 3) (13.1% [42/321]), risk ratio 1.22 (95% CI 0.84 to 1.78); however, the contribution of clinically diagnosed treatment initiations were higher in x-ray groups (50.9% vs 19.0%).

conclusionsXpert Ultra performed similarly to Xpert MTB/RIF. X-rays are useful for TB screening but further research should investigate how to mitigate false-positive treatment initiations.

Indexed as

HIV InfectionsMycobacterium tuberculosisTuberculosis, PulmonaryAmbulatory Care FacilitiesHumansRadiographySensitivity and SpecificitySputumdiagnosisHIVradiographyTB

Identifiers

PMID35963826
PMCPMC9808509
OpenAlexW4291397979

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

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.