{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T11:54:27Z","timestamp":1770724467590,"version":"3.49.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2018,7,27]],"date-time":"2018-07-27T00:00:00Z","timestamp":1532649600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AI093316"],"award-info":[{"award-number":["R01AI093316"]}],"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":["P30AI094189"],"award-info":[{"award-number":["P30AI094189"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Wellcome Trust Senior Fellowship","award":["WT200901\/Z\/16\/Z"],"award-info":[{"award-number":["WT200901\/Z\/16\/Z"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,3,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Tuberculosis (TB) remains the leading cause of death among human immunodeficiency virus (HIV)\u2013infected individuals globally. Screening for TB at the point of HIV diagnosis with a high-sensitivity assay presents an opportunity to reduce mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a cluster randomized trial of TB screening among adults newly diagnosed with HIV in 12 primary health clinics in rural Thyolo, Malawi. Clinics were allocated in a 1:1 ratio to perform either point-of-care Xpert MTB\/RIF assay (Xpert) or point-of-care light-emitting diode fluorescence microscopy (LED-FM) for individuals screening positive for TB symptoms. Asymptomatic participants were offered isoniazid preventive therapy in both arms. Investigators, but not clinic staff or participants, were masked to allocation. Our primary outcome was the incidence rate ratio (RR) of all-cause mortality within 12 months of HIV diagnosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Prevalent TB was diagnosed in 24 of 1001 (2.4%) individuals enrolled in clinics randomized to Xpert, compared with 10 of 841 (1.2%) in clinics randomized to LED-FM. All-cause mortality was 22% lower in the Xpert arm than in the LED-FM arm (6.7 vs 8.6 per 100 person-years; RR, 0.78 [95% confidence interval {CI}, .58\u20131.06]). A planned subgroup analysis suggested that participants with more advanced HIV (World Health Organization clinical stage 3 or 4) disease had lower mortality in clinics randomized to Xpert than to LED-FM (RR, 0.43 [95% CI, .22\u2013.87]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In rural Malawi, using point-of-care Xpert MTB\/RIF to test symptomatic patients for TB at the time of HIV diagnosis reduced all-cause 12-month mortality among individuals with advanced HIV.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Trials Registration<\/jats:title>\n                  <jats:p>NCT01450085.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciy590","type":"journal-article","created":{"date-parts":[[2018,7,25]],"date-time":"2018-07-25T15:10:57Z","timestamp":1532531457000},"page":"1176-1183","source":"Crossref","is-referenced-by-count":21,"title":["Screening for Tuberculosis With Xpert MTB\/RIF Assay Versus Fluorescent Microscopy Among Adults Newly Diagnosed With Human Immunodeficiency Virus in Rural Malawi: A Cluster Randomized Trial (Chepetsa)"],"prefix":"10.1093","volume":"68","author":[{"given":"Lucky G","family":"Ngwira","sequence":"first","affiliation":[{"name":"HIV and TB Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre"},{"name":"Clinical Sciences Department, Liverpool School of Tropical Medicine, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth L","family":"Corbett","sequence":"additional","affiliation":[{"name":"HIV and TB Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre"},{"name":"TB Centre, London School of Hygiene and Tropical Medicine, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"McEwen","family":"Khundi","sequence":"additional","affiliation":[{"name":"HIV and TB Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace L","family":"Barnes","sequence":"additional","affiliation":[{"name":"Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Austin","family":"Nkhoma","sequence":"additional","affiliation":[{"name":"HIV and TB Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Murowa","sequence":"additional","affiliation":[{"name":"Malawi Ministry of Health, Lilongwe, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Cohn","sequence":"additional","affiliation":[{"name":"Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence H","family":"Moulton","sequence":"additional","affiliation":[{"name":"Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland"},{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard E","family":"Chaisson","sequence":"additional","affiliation":[{"name":"Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland"},{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"},{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W","family":"Dowdy","sequence":"additional","affiliation":[{"name":"Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland"},{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"},{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,7,27]]},"reference":[{"key":"2019100103233679700_CIT0001","volume-title":"Global tuberculosis report 2017","author":"World Health Organization","year":"2017"},{"key":"2019100103233679700_CIT0002","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1056\/NEJMoa0907847","article-title":"Rapid molecular detection of tuberculosis and 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results of the TB fast\n          track trial [abstract 155]. In: Conference on Retroviruses and Opportunistic Infections, Boston, MA, 22\u201325 February 2016."},{"key":"2019100103233679700_CIT0029","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/S1473-3099(13)70360-8","article-title":"Do high rates of empirical treatment undermine the potential effect of new diagnostic tests for tuberculosis in high-burden settings","volume":"14","author":"Theron","year":"2014","journal-title":"Lancet Infect Dis"},{"key":"2019100103233679700_CIT0030","volume-title":"GeneXpert Omni","author":"Cepheid, Inc"},{"key":"2019100103233679700_CIT0031","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1093\/cid\/ciw817","article-title":"Combatting global infectious diseases: a network effect of specimen referral systems","volume":"64","author":"Fonjungo","year":"2017","journal-title":"Clin Infect Dis"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/68\/7\/1176\/30090296\/ciy590.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T03:23:55Z","timestamp":1569900235000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/68\/7\/1176\/5060257"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,27]]},"references-count":31,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2018,7,27]]},"published-print":{"date-parts":[[2019,3,19]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciy590","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,4,1]]},"published":{"date-parts":[[2018,7,27]]}}}