{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T17:17:32Z","timestamp":1788369452511,"version":"build-2803163510"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,9,5]],"date-time":"2024-09-05T00:00:00Z","timestamp":1725494400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32AI007384"],"award-info":[{"award-number":["T32AI007384"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004768","name":"MTB","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004768","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>An accurate, rapid, non-sputum-based triage test for diagnosing tuberculosis (TB) is needed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A prospective evaluation of the Cepheid GeneXpert Mycobacterium tuberculosis Host Response cartridge (Xpert-MTB-HR), a prototype blood-based host response mRNA signature assay, among individuals presenting with TB-like symptoms was performed in Pakistan and results were compared to 3 reference standards: Xpert MTB\/RIF Ultra, bacteriological confirmation (Xpert MTB\/RIF Ultra and\/or culture positivity), and composite clinical diagnosis (clinician diagnosis, treatment initiation, Xpert MTB\/RIF Ultra, and\/or culture positivity). Analyses were conducted both for the entire study cohort and separately in the adolescent and young adult cohort (aged 10\u201324 years).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 497 participants, aged 6\u201383 years, returned valid Xpert-MTB-HR results. When a diagnostic threshold was set for a sensitivity of &amp;gt;90%, specificity was 32% (95% confidence interval [CI], 28%\u201337%) compared to Xpert MTB\/RIF Ultra, 29% (95% CI, 25%\u201334%) compared to a bacteriological confirmation, and 22% (95% CI, 18%\u201326%) compared to a composite clinical diagnosis. However, when evaluating only the adolescent and young adult cohort with a diagnostic threshold set for sensitivity of &amp;gt;90%, specificity was 82% (95% CI, 74%\u201389%) compared to Xpert MTB\/RIF Ultra, 84% (95% CI, 75%\u201390%) compared to a bacteriological confirmation, and 54% (95% CI, 44%\u201364%) compared to a composite clinical diagnosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>While the Xpert-MTB-HR does not meet World Health Organization minimum criteria in the general population, in our study it does meet the minimum sensitivity and specificity requirements for a non-sputum-based triage test among adolescents and young adults when compared to Xpert MTB\/RIF Ultra or bacteriological confirmation.<\/jats:p>\n               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