{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:17:40Z","timestamp":1789579060380,"version":"build-2803163510"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T00:00:00Z","timestamp":1627344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Free State Department of Health","award":["DoH (FS) 81\/2016\/2017"],"award-info":[{"award-number":["DoH (FS) 81\/2016\/2017"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Optimized tuberculosis (TB) screening in high burden settings is essential for case finding. We evaluated digital chest X-ray with computer-aided detection (CAD) software (d-CXR) for identifying undiagnosed TB in three primary health clinics in South Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The cross-sectional study consented adults who were sequentially screened for TB using the World Health Organization (WHO) 4 symptom questionnaire and d-CXR. Participants reporting \u22651 TB symptom and\/or CAD score \u226560 (suggestive of TB) provided 2 spot sputum for Xpert MTB\/RIF Ultra (Xpert Ultra) and liquid culture testing, respectively. TB yield (proportion of screened tested positive) and number needed to test (NNT; no of tests to identify one TB patient) were calculated. Risk factors for microbiologically confirmed or presumed (on radiological grounds) were determined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3041 participants, 45% (1356 of 3041) screened positive on either d-CXR or symptoms. TB yield was 2.3% (71 of 3041) using Xpert Ultra and 2.7% (82 of 3041) using Xpert Ultra plus culture. Modelled TB yield (identified by Xpert Ultra) by screening approach was: 1.9% (59 of 3041) for d-CXR alone, 2.0% (62 of 3041) for symptoms alone and 2.3% (71 of 3041) for both. The NNT was 9.7 for d-CXR, 17.8 for symptoms and 19.1 for d-CXR and\/or symptom. Males, those with previous TB, untreated HIV or unknown HIV status, and acute illness were at higher risk of developing TB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>d-CXR screening identified a similar yield of undiagnosed TB compared to symptom-based screening, however required fewer diagnostic tests. Due to its objective nature, d-CXR screening may improve case detection in clinics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciab644","type":"journal-article","created":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T07:10:12Z","timestamp":1627369812000},"page":"1650-1658","source":"Crossref","is-referenced-by-count":24,"title":["Digital Chest Radiography Enhances Screening Efficiency for Pulmonary Tuberculosis in Primary Health Clinics in South Africa"],"prefix":"10.1093","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0375-2438","authenticated-orcid":false,"given":"Nishila","family":"Moodley","sequence":"first","affiliation":[{"name":"Implementation Research Division, Aurum Institute, Johannesburg, South Africa"},{"name":"Division of Tropical Health and Medicine, College of Medicine and Dentistry, James Cook University, Townsville, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8577-3915","authenticated-orcid":false,"given":"Kavindhran","family":"Velen","sequence":"additional","affiliation":[{"name":"Implementation Research Division, Aurum Institute, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amashnee","family":"Saimen","sequence":"additional","affiliation":[{"name":"Implementation Research Division, Aurum Institute, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noor","family":"Zakhura","sequence":"additional","affiliation":[{"name":"TB Unit, Free State Department of Health, Free State Province, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"Churchyard","sequence":"additional","affiliation":[{"name":"Implementation Research Division, Aurum Institute, Johannesburg, South Africa"},{"name":"School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salome","family":"Charalambous","sequence":"additional","affiliation":[{"name":"Implementation Research Division, Aurum Institute, Johannesburg, South Africa"},{"name":"School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,7,27]]},"reference":[{"key":"2022050517221672300_CIT0001","year":"2020"},{"key":"2022050517221672300_CIT0002","author":"National Department of Health.","year":"2017"},{"key":"2022050517221672300_CIT0003","author":"World Health Organization.","year":"2013"},{"key":"2022050517221672300_CIT0004","doi-asserted-by":"crossref","first-page":"e0138149","DOI":"10.1371\/journal.pone.0138149","article-title":"Missed opportunities for TB investigation in primary care clinics in South Africa: Experience from the XTEND trial","volume":"10","author":"Chihota","year":"2015","journal-title":"PLoS One"},{"key":"2022050517221672300_CIT0005","doi-asserted-by":"crossref","first-page":"e0181519","DOI":"10.1371\/journal.pone.0181519","article-title":"A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa","volume":"12","author":"Hanifa","year":"2017","journal-title":"PloS One"},{"key":"2022050517221672300_CIT0006","doi-asserted-by":"crossref","first-page":"e1001760","DOI":"10.1371\/journal.pmed.1001760","article-title":"Impact of Xpert MTB\/RIF for TB diagnosis in a primary care clinic with high TB and HIV prevalence in South Africa: a pragmatic randomised trial","volume":"11","author":"Cox","year":"2014","journal-title":"PLoS Med"},{"key":"2022050517221672300_CIT0007","doi-asserted-by":"crossref","first-page":"e0150487","DOI":"10.1371\/journal.pone.0150487","article-title":"Comparing tuberculosis diagnostic yield in smear\/culture and Xpert(R) MTB\/RIF-based algorithms using a non-randomised stepped-wedge design","volume":"11","author":"Naidoo","year":"2016","journal-title":"PLoS One"},{"key":"2022050517221672300_CIT0008","doi-asserted-by":"crossref","first-page":"e119","DOI":"10.1097\/QAI.0000000000000907","article-title":"Implementation and operational research: What happens after a negative test for tuberculosis? 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