{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T03:15:38Z","timestamp":1783480538306,"version":"3.55.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HL153611"],"award-info":[{"award-number":["R01HL153611"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100021281","name":"Gates Foundation","doi-asserted-by":"publisher","award":["INV-042921"],"award-info":[{"award-number":["INV-042921"]}],"id":[{"id":"10.13039\/100021281","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100021281","name":"Gates Foundation","doi-asserted-by":"publisher","award":["OPP1213504"],"award-info":[{"award-number":["OPP1213504"]}],"id":[{"id":"10.13039\/100021281","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Some patients who test trace positive on Xpert MTB\/RIF Ultra (\u201cUltra\u201d), a highly sensitive molecular diagnostic platform, may not have tuberculosis (TB) disease. A better understanding of the prevalence of TB, associated clinical characteristics, and utility of additional diagnostic tests among people with trace sputum (PWTS) could aid clinical decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We enrolled adults and adolescents with trace-positive sputum on initial TB diagnostic evaluation in Uganda and South Africa. Participants were extensively evaluated at enrollment; those with uncertain TB status were followed off treatment, with interval reevaluations by TB clinicians, for up to 3 months. We assessed TB prevalence and associated patient characteristics and diagnostic results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 311 PWTS, TB was identified by sputum culture at enrollment in 20% of participants (61\/311, 95% CI 15%\u201324%). Within 3 months, 48% (145\/301, 95% CI 43%\u201354%) had been judged to warrant TB treatment, and among those followed until microbiologic outcomes, 30% (68\/227, 95% CI 24%\u201336%) had positive culture and 41% (99\/240, 95% CI 35%\u201347%) had positive culture or Ultra. Two participants died. Having TB symptoms, advanced human immunodeficiency virus (HIV), and no recent TB history were associated with microbiologically confirmed TB disease, as were an abnormal chest X-ray (in those without recent TB) or elevated C-reactive protein (CRP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Roughly half of PWTS were recommended TB therapy. This prevalence supports treating most PWTS when multimodal testing and repeated clinical evaluations are infeasible. However, given low observed mortality, some people with low-risk characteristics and negative results on other widely available diagnostic tests could safely defer treatment with clinical follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag019","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T08:19:32Z","timestamp":1773994772000},"page":"e1302-e1310","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence and Predictors of Tuberculosis in Adults and Adolescents With Sputum Trace Ultra Results in 2 High-Burden Clinical Settings"],"prefix":"10.1093","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5132-2092","authenticated-orcid":false,"given":"Caitlin","family":"Visek","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronit R","family":"Dalmat","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington , Seattle, Washington ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3903-303X","authenticated-orcid":false,"given":"Annet","family":"Nalutaaya","sequence":"additional","affiliation":[{"name":"Uganda Tuberculosis Implementation Research Consortium, Walimu , Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamoga Caleb","family":"Erisa","sequence":"additional","affiliation":[{"name":"Uganda Tuberculosis Implementation Research Consortium, Walimu , Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Bich\u00e9","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5703-7422","authenticated-orcid":false,"given":"Gabrielle","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington , Seattle, Washington ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Ganguloo","sequence":"additional","affiliation":[{"name":"Umkhuseli Innovation and Research Management , Pietermaritzburg ,","place":["South Africa"]},{"name":"Department of Internal Medicine, Harry Gwala Regional Hospital, University of KwaZulu-Natal , Pietermaritzburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Draper","sequence":"additional","affiliation":[{"name":"Umkhuseli Innovation and Research Management , Pietermaritzburg ,","place":["South Africa"]},{"name":"Department of Internal Medicine, Harry Gwala Regional Hospital, University of KwaZulu-Natal , Pietermaritzburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam","family":"Nantale","sequence":"additional","affiliation":[{"name":"Uganda Tuberculosis Implementation Research Consortium, Walimu , Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrienne E","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington , Seattle, Washington ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7756-8660","authenticated-orcid":false,"given":"Douglas","family":"Wilson","sequence":"additional","affiliation":[{"name":"Umkhuseli Innovation and Research Management , Pietermaritzburg ,","place":["South Africa"]},{"name":"Department of Internal Medicine, Harry Gwala Regional Hospital, University of KwaZulu-Natal , Pietermaritzburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achilles","family":"Katamba","sequence":"additional","affiliation":[{"name":"Uganda Tuberculosis Implementation Research Consortium, Walimu , Kampala ,","place":["Uganda"]},{"name":"Clinical Epidemiology & Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences , Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9569-4097","authenticated-orcid":false,"given":"Paul K","family":"Drain","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington , Seattle, Washington ,","place":["USA"]},{"name":"Department of Epidemiology, University of Washington , Seattle, Washington ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily A","family":"Kendall","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland ,","place":["USA"]},{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"2026070722315948700_ciag019-B1","volume-title":"Global Tuberculosis Report 2024","year":"2024"},{"key":"2026070722315948700_ciag019-B2","doi-asserted-by":"crossref","first-page":"e00812","DOI":"10.1128\/mBio.00812-17","article-title":"The new Xpert MTB\/RIF Ultra: improving detection of Mycobacterium tuberculosis and resistance to rifampin in an assay suitable for point-of-care testing","volume":"8","author":"Chakravorty","year":"2017","journal-title":"mBio"},{"key":"2026070722315948700_ciag019-B3","doi-asserted-by":"crossref","first-page":"e058195","DOI":"10.1136\/bmjopen-2021-058195","article-title":"Optimising Xpert-Ultra and culture testing to reliably measure tuberculosis prevalence in the community: findings from surveys in Zambia and South Africa","volume":"12","author":"Floyd","year":"2022","journal-title":"BMJ Open"},{"key":"2026070722315948700_ciag019-B4"},{"key":"2026070722315948700_ciag019-B5","doi-asserted-by":"crossref","first-page":"28","DOI":"10.5588\/pha.21.0066","article-title":"Prevalence and interpretation of Xpert Ultra trace results among presumptive TB patients","volume":"12","author":"Chilukutu","year":"2022","journal-title":"Public Health Action"},{"key":"2026070722315948700_ciag019-B6","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/S1473-3099(17)30691-6","article-title":"Xpert MTB\/RIF Ultra for detection of 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states to guide research for improved care and prevention: an international Delphi consensus exercise","volume":"12","author":"Coussens","year":"2024","journal-title":"Lancet Respir Med"},{"key":"2026070722315948700_ciag019-B13","doi-asserted-by":"crossref","first-page":"e00021-18","DOI":"10.1128\/CMR.00021-18","article-title":"Incipient and subclinical tuberculosis: a clinical review of early stages and progression of infection","volume":"31","author":"Drain","year":"2018","journal-title":"Clin Microbiol Rev"},{"key":"2026070722315948700_ciag019-B14","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/S2213-2600(23)00097-8","article-title":"The natural history of untreated pulmonary tuberculosis in adults: a systematic review and meta-analysis","volume":"11","author":"Sossen","year":"2023","journal-title":"Lancet Respir 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