{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T19:14:57Z","timestamp":1783365297117,"version":"3.54.6"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T00:00:00Z","timestamp":1715817600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,29]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The World Health Organization recommends systematic chest X-ray (CXR) screening for tuberculosis (TB) in silica-exposed workers. However, evidence on the accuracy of CXR screening in such populations is lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To measure the accuracy of CXR screening for active TB in silica-exposed miners, in a population with a high prevalence of silicosis, post-TB lung disease and HIV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A secondary analysis of data from a miner screening programme in Lesotho was undertaken. We measured the performance of CXR (in participants with and without cough) for \u2018abnormalities suggestive of TB\u2019 against Xpert MTB\/RIF (Xpert). The sample size was 2572 and positive Xpert prevalence was 3%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>CXR alone had high sensitivity (0.93, 95% confidence interval [CI] 0.87\u20130.99), but low specificity (0.41, 95% CI 0.39\u20130.42). Requiring cough and a positive CXR increased specificity (0.79, 95% CI 0.77\u20130.81), resulting in reduced sensitivity (0.41, 95% CI 0.30\u20130.52). There was no difference in CXR accuracy by HIV status. However, specificity was markedly reduced in the presence of silicosis (from 0.70, 95% CI 0.68\u20130.72, to 0.03, 95% CI 0.02\u20130.04) or past TB history (from 0.59, 95% CI 0.56\u20130.62 to 0.27, 95% CI 0.25\u20130.29). Throughout, positive predictive value remained very low (5%) and negative predictive value very high (99%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CXR screening accurately identifies TB-negative CXRs in this population, but post-TB lung disease and silicosis would result in a high proportion of Xpert-negative referrals and an increased risk of unneeded empirical treatment. Adapted screening algorithms, practitioner training and digital access to previous mining CXRs are needed.<\/jats:p><\/jats:sec>","DOI":"10.1093\/occmed\/kqae043","type":"journal-article","created":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T10:58:40Z","timestamp":1715857120000},"page":"386-391","source":"Crossref","is-referenced-by-count":2,"title":["Accuracy of chest x-ray screening of silica-exposed miners for tuberculosis"],"prefix":"10.1093","volume":"74","author":[{"given":"B","family":"Maboso","sequence":"first","affiliation":[{"name":"University of Cape Town Division of Occupational Medicine, School of Public Health, , Cape Town , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5736-9237","authenticated-orcid":false,"given":"R I","family":"Ehrlich","sequence":"additional","affiliation":[{"name":"University of Cape Town Division of Occupational Medicine, School of Public Health, , Cape Town , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,5,16]]},"reference":[{"key":"2024081605304830900_CIT0001","volume-title":"WHO Consolidated Guidelines on Tuberculosis. 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