{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T19:17:57Z","timestamp":1785525477806,"version":"3.56.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Community-wide screening for bacteriologically confirmed pulmonary tuberculosis may reduce the tuberculosis burden, although concerns of overtreatment remain because of false positive diagnoses due to subpar specificity of current bacteriological tests for screening. Our review and data analysis show that clinic-based test specificity estimates of Xpert against culture underestimate performance in communities, for both Xpert MTB\/RIF(99.8% for community vs 98.4% for clinic) and Xpert Ultra (99.4% vs 95.6%, respectively), reducing the presumed false positivity of sputum Xpert, using culture as the reference, by 86.8% and 85.4%, respectively, compared with clinic-based specificity estimates. These findings support large-scale evaluation of community-wide screening for tuberculosis.<\/jats:p>","DOI":"10.1093\/infdis\/jiaf268","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T21:47:10Z","timestamp":1748036830000},"source":"Crossref","is-referenced-by-count":11,"title":["Mind the Clinic-Community Gap: Re-evaluation of Test Performance and False Positive Results in Community-Wide Tuberculosis Screening"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2230-4884","authenticated-orcid":false,"given":"Lara D","family":"Veeken","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Radboud Community for Infectious Diseases, Radboud University Medical Center , Nijmegen ,","place":["The Netherlands"]},{"name":"TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine , London ,","place":["United Kingdom"]},{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6518-9719","authenticated-orcid":false,"given":"Alvaro","family":"Schwalb","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine , London ,","place":["United Kingdom"]},{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , London ,","place":["United Kingdom"]},{"name":"Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia , Lima ,","place":["Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7542-4065","authenticated-orcid":false,"given":"Katherine C","family":"Horton","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine , London ,","place":["United Kingdom"]},{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3817-4589","authenticated-orcid":false,"given":"Raspati C","family":"Koesoemadinata","sequence":"additional","affiliation":[{"name":"Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran , Bandung ,","place":["Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3745-8229","authenticated-orcid":false,"given":"Bachti","family":"Alisjahbana","sequence":"additional","affiliation":[{"name":"Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran , Bandung ,","place":["Indonesia"]},{"name":"Department of Internal Medicine, Dr Hasan Sadikin General Hospital , Bandung ,","place":["Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6233-6410","authenticated-orcid":false,"given":"Reinout","family":"van Crevel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Radboud Community for Infectious Diseases, Radboud University Medical Center , Nijmegen ,","place":["The Netherlands"]},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford , Oxford ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4132-7467","authenticated-orcid":false,"given":"Rein M G J","family":"Houben","sequence":"additional","affiliation":[{"name":"TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine , London ,","place":["United Kingdom"]},{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,5,23]]},"reference":[{"key":"2025061310264722000_jiaf268-B1"},{"key":"2025061310264722000_jiaf268-B2"},{"key":"2025061310264722000_jiaf268-B3","doi-asserted-by":"crossref","first-page":"e1158","DOI":"10.1093\/infdis\/jiae390","article-title":"Estimating the impact of tuberculosis pathways on transmission\u2014what is the gap left by passive case finding?","volume":"230","author":"Horton","year":"2024","journal-title":"J Infect Dis"},{"key":"2025061310264722000_jiaf268-B4","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1056\/NEJMoa1902129","article-title":"Community-wide screening for tuberculosis in a high-prevalence setting","volume":"381","author":"Marks Guy","year":"2019","journal-title":"N Engl J 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The consequences and trade-offs involved in false-positive diagnoses of tuberculosis","volume":"68","author":"Houben","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2025061310264722000_jiaf268-B8","doi-asserted-by":"crossref","first-page":"E925","DOI":"10.1503\/cmaj.221802","article-title":"The association of sensitivity and specificity with disease prevalence: analysis of 6909 studies of diagnostic test accuracy","volume":"195","author":"Murad","year":"2023","journal-title":"CMAJ Can Med Assoc J"},{"key":"2025061310264722000_jiaf268-B9","first-page":"CD009593","article-title":"Xpert ultra versus Xpert MTB\/RIF for pulmonary tuberculosis and rifampicin resistance in adults with presumptive pulmonary tuberculosis","volume":"2","author":"Zifodya","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"2025061310264722000_jiaf268-B10","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1016\/S1473-3099(16)30067-6","article-title":"Reassessment of the positive predictive value and specificity of Xpert MTB\/RIF: a diagnostic accuracy study in the context of community-wide screening for tuberculosis","volume":"16","author":"Ho","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"2025061310264722000_jiaf268-B11","doi-asserted-by":"crossref","first-page":"e1035","DOI":"10.1093\/cid\/ciaa1824","article-title":"The spectrum of tuberculosis disease in an urban Ugandan community and its health facilities","volume":"72","author":"Kendall","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2025061310264722000_jiaf268-B12","first-page":"158","article-title":"Diagnostic value of repeated sputum examinations in pulmonary tuberculosis: how many sputum specimens are adequate?","volume":"56","author":"Yilmaz","year":"2008","journal-title":"Tuberk Ve Toraks"},{"key":"2025061310264722000_jiaf268-B13","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1093\/cid\/ciad595","article-title":"Evidence for tuberculosis in individuals with Xpert Ultra \u201ctrace\u201d sputum during screening of high-burden communities","volume":"78","author":"Sung","year":"2024","journal-title":"Clin Infect Dis"},{"key":"2025061310264722000_jiaf268-B14","author":"Dinkele"},{"key":"2025061310264722000_jiaf268-B15","doi-asserted-by":"crossref","first-page":"e01696-17","DOI":"10.1128\/JCM.01696-17","article-title":"False-positive Xpert MTB\/RIF results in retested patients with previous tuberculosis: frequency, profile, and prospective clinical outcomes","volume":"56","author":"Theron","year":"2018","journal-title":"J Clin Microbiol"}],"container-title":["The Journal of Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jid\/advance-article-pdf\/doi\/10.1093\/infdis\/jiaf268\/63314121\/jiaf268.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jid\/advance-article-pdf\/doi\/10.1093\/infdis\/jiaf268\/63314121\/jiaf268.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T14:26:57Z","timestamp":1749824817000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jid\/advance-article\/doi\/10.1093\/infdis\/jiaf268\/8142706"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,23]]},"references-count":15,"URL":"https:\/\/doi.org\/10.1093\/infdis\/jiaf268","relation":{},"ISSN":["0022-1899","1537-6613"],"issn-type":[{"value":"0022-1899","type":"print"},{"value":"1537-6613","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,23]]},"article-number":"jiaf268"}}