{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T06:11:47Z","timestamp":1787897507126,"version":"build-2784847793"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001322","name":"South African Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Collaborating Centres Programme"},{"DOI":"10.13039\/100009041","name":"National Department of Health","doi-asserted-by":"publisher","award":["RFA SAMRC-RFA-CC: TB\/HIV\/AIDS-01-2014"],"award-info":[{"award-number":["RFA SAMRC-RFA-CC: TB\/HIV\/AIDS-01-2014"]}],"id":[{"id":"10.13039\/100009041","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["098316"],"award-info":[{"award-number":["098316"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["214321\/Z\/18\/Z"],"award-info":[{"award-number":["214321\/Z\/18\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["203135\/Z\/16\/Z"],"award-info":[{"award-number":["203135\/Z\/16\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"name":"South African Research Chairs Initiative of the Department of Science and Technology"},{"DOI":"10.13039\/501100001321","name":"National Research Foundation","doi-asserted-by":"publisher","award":["64787"],"award-info":[{"award-number":["64787"]}],"id":[{"id":"10.13039\/501100001321","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K43TW011421"],"award-info":[{"award-number":["K43TW011421"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01AI170426"],"award-info":[{"award-number":["U01AI170426"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Urine lateral flow lipoarabinomannan (LF-LAM) is a point-of-care tuberculosis (TB) test for patients with human immunodeficiency virus (HIV). Xpert MTB\/RIF Ultra (Ultra) has improved sensitivity on sputum compared with the previous generation of Xpert and may improve diagnostic yield for TB on urine-based testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a diagnostic accuracy study in East London, South Africa. Adults with HIV hospitalized with \u22651 W4SS (World Health Organization\u2013recommended 4-symptom screen) or clinical concern for TB were enrolled; TB cultures were performed on blood, sputum, and urine. Unprocessed urine was tested with LF-LAM and Ultra on the pellet of 15\u2005mL centrifuged urine. The primary outcome was sensitivity of urine Ultra compared with LF-LAM, with microbiological TB (positive TB culture or molecular test, excluding urine Ultra) as the reference. Secondary outcomes included specificity and diagnostic yield.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Two hundred thirty-eight participants were enrolled with a median CD4 count of 76\u2005cells\/mm3. Microbiological TB was diagnosed in 62 (26%). Using microbiological TB as the reference, sensitivity of LF-LAM and urine Ultra was 45% (95% confidence interval, 32\u201358) and 70% (95% CI, 57\u201381; McNemar P = .0013); specificity was 93% (95% CI, 81\u201399) and 100% (95% CI, 92\u2013100; McNemar P = .25). Diagnostic yields for microbiological TB were 34% for sputum Ultra, 45% for urine LF-LAM, 68 for urine Ultra, and 73% for urine LF-LAM and urine Ultra combined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Combined urine-based testing (Ultra + LF-LAM) identified nearly three-quarters of medical inpatients with HIV with microbiological TB. Urine Ultra had significantly improved sensitivity compared with LF-LAM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf080","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T07:34:41Z","timestamp":1740468881000},"page":"e146-e152","source":"Crossref","is-referenced-by-count":6,"title":["Comparative Performance of Urine Lipoarabinomannan and Urine Xpert MTB\/RIF Ultra for Diagnosing Tuberculosis in Adult Inpatients With HIV in East London, South Africa"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2908-7176","authenticated-orcid":false,"given":"David","family":"Stead","sequence":"first","affiliation":[{"name":"Department of Medicine, Frere and Cecilia Makiwane Hospitals , East London ,","place":["South Africa"]},{"name":"Department of Medicine, Faculty of Health Sciences, Walter Sisulu University , Mthatha ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3508-6719","authenticated-orcid":false,"given":"Sean","family":"Wasserman","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]},{"name":"Institute for Infection and Immunity, St George's, University of London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7657-265X","authenticated-orcid":false,"given":"Ebrahim","family":"Steenkamp","sequence":"additional","affiliation":[{"name":"Department of Statistical Sciences, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3621-2318","authenticated-orcid":false,"given":"Andy","family":"Parrish","sequence":"additional","affiliation":[{"name":"Department of Medicine, Frere and Cecilia Makiwane Hospitals , East London ,","place":["South Africa"]},{"name":"Department of Medicine, Faculty of Health Sciences, Walter Sisulu University , Mthatha ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2922-9381","authenticated-orcid":false,"given":"David","family":"Barr","sequence":"additional","affiliation":[{"name":"Department Infectious Diseases, Queen Elizabeth University Hospital , Glasgow ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1196-4414","authenticated-orcid":false,"given":"Graeme","family":"Meintjes","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]},{"name":"Department of Medicine, University of Cape Town , Cape Town,","place":["South Africa"]},{"name":"Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"2025110901573208700_ciaf080-B1"},{"key":"2025110901573208700_ciaf080-B2","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/S1473-3099(19)30695-4","article-title":"Mycobacterium tuberculosis bloodstream infection prevalence, diagnosis, and mortality risk in seriously ill adults with HIV: a systematic review and meta-analysis of individual patient data","volume":"20","author":"Barr","year":"2020","journal-title":"Lancet Infect 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