ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2026
Diagnostic Accuracy of Tuberculosis Screening Tests in a Prospective Multinational Cohort: Chest Radiography With Computer-Aided Detection, Xpert Tuberculosis Host Response, and C-Reactive Protein.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04923958 (Rapid Research in Diagnostics Development for TB Network), which is not on this map. Cited by 12 papers.
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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.
Rapid Research in Diagnostics Development for TB Network (R2D2 TB Network) Study
Who cites it
12 citing papers in PubMed.
- A multi-omics study reveals pathway-level insights and predictive biomarkers in pediatric TB.Clinical proteomics · 2026Article
- Sputum scarcity and associated factors in people undergoing tuberculosis testing in South Africa, Uganda, India, and the Philippines: an analysis of cross-sectional observational data.EClinicalMedicine · 2026Article
- Improving Tuberculosis Diagnosis Through Artificial Intelligence (CAD4TB) and Stool Xpert MTB/RIF Testing: A Prospective Study From Oromia, Ethiopia.Open forum infectious diseases · 2026Article
- Integrating AI with PCR for Tuberculosis Diagnosis: Evaluating a Deep Learning Model for Chest X-Rays.Bioengineering (Basel, Switzerland) · 2025Article
- Whom tuberculosis tests detect and why it matters: implications for diagnostic algorithms.The Lancet. Microbe · 2025Review
- Evaluation of an ultra-portable X-ray system with automated interpretation for tuberculosis active case finding in carceral settings: a diagnostic test accuracy study.BMC infectious diseases · 2025Article
- Screening for asymptomatic tuberculosis among adults with household exposure to pulmonary tuberculosis: a prospective observational cohort study.The Lancet. Global health · 2025Observational
- Accelerating Cough-Based Algorithms for Pulmonary Tuberculosis Screening: Results From the CODA TB DREAM Challenge.Open forum infectious diseases · 2025Article
- Article
- Tongue Swab Xpert MTB/RIF Ultra Testing for Tuberculosis Using a Revised Consensus Protocol: A multi-country diagnostic accuracy study.medRxiv : the preprint server for health sciences · 2025Article
- Evaluation of host-immune biomarker signatures as multiplex qPCR diagnostic assays: a pilot study toward meeting WHO target product profiles for TB diagnosis in India.Frontiers in tuberculosis · 2025Article
- Sputum host cytokine signatures for diagnosis of TB in children and adults.Frontiers in immunology · 2025Article
Corrections and comments
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Authors and funding
19 authors.
Funding
Abstract
backgroundAccessible, accurate screening tests are necessary to advance tuberculosis case finding and early detection in high-burden countries.
methodsWe prospectively screened adults with ≥2 weeks of cough at primary health centers in the Philippines, Vietnam, South Africa, Uganda, and India. Participants underwent chest radiography, Cepheid Xpert TB Host Response (Xpert HR) testing, and point-of-care C-reactive protein (CRP) testing (Boditech). Chest radiographs were processed using CAD4TB v7, a computer-aided detection (CAD) algorithm. We assessed diagnostic accuracy against a microbiologic reference standard (sputum Xpert Ultra, culture). Optimal cutoff points were chosen to maximize specificity at 90% sensitivity. Two-test screening algorithms were considered, using (1) sequential negative serial screening (with positive defined as positive on either test) and (2) sequential positive serial screening (with positive defined as positive on both tests).
resultsBetween July 2021 and August 2022, a total of 1392 participants with presumptive tuberculosis had valid index tests and reference standard results, and 303 (22%) had confirmed tuberculosis. In head-to-head comparisons, CAD4TB v7 showed the highest specificity at 90% sensitivity (70.3% vs 65.1% for Xpert HR [95% confidence interval for absolute difference in specificity, 1.6%-8.9%] and vs 49.7% for CRP [17.0%-24.3%]). Three 2-test screening algorithms met World Health Organization target product profile minimum accuracy thresholds and had higher accuracy than any test alone. At 90% sensitivity, the specificity was 79.6% for Xpert HR-CAD4TB (sequential negative), 75.9% for CRP-CAD4TB (sequential negative), and 73.7% for Xpert HR-CAD4TB (sequential positive).
conclusionsCAD4TB achieves target product profile targets and outperforms Xpert HR and CRP. Combining screening tests further increased accuracy. Clinical Trials Registration. NCT04923958.
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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.