{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T20:13:34Z","timestamp":1790453614336,"version":"4.1.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2020,3,24]],"date-time":"2020-03-24T00:00:00Z","timestamp":1585008000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wellcome Trust Clinical PhD Fellowship","award":["210772\/Z\/18\/Z"],"award-info":[{"award-number":["210772\/Z\/18\/Z"]}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurologic Disorders and Stroke","doi-asserted-by":"crossref","award":["R01NS086312"],"award-info":[{"award-number":["R01NS086312"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurologic Disorders and Stroke","doi-asserted-by":"crossref","award":["K23NS110470"],"award-info":[{"award-number":["K23NS110470"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["K01TW010268"],"award-info":[{"award-number":["K01TW010268"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["T32AI055433"],"award-info":[{"award-number":["T32AI055433"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI145437"],"award-info":[{"award-number":["R01AI145437"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"name":"DELTAS Africa Initiative","award":["107743"],"award-info":[{"award-number":["107743"]}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["107743"],"award-info":[{"award-number":["107743"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Diagnosis of extrapulmonary tuberculosis (TB) remains challenging. We sought to determine the prevalence of disseminated TB by testing urine with TB-lipoarabinomannan (TB-LAM) lateral flow assay and Xpert MTB\/RIF Ultra (Ultra) in hospitalized adults.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We prospectively enrolled human immunodeficiency virus (HIV)-positive adults with suspected meningitis in Uganda during 2018\u20132020. Participants underwent standardized urine-based TB screening. Urine (60 mcL) was tested with TB-LAM (Alere), and remaining urine was centrifuged with the cell pellet resuspended in 2 mL of urine for Xpert Ultra testing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We enrolled 348 HIV-positive inpatients with median CD4 of 37 cells\/mcL (interquartile range, 13\u2013102 cells\/mcL). Overall, 26% (90 of 348; 95% confidence interval [CI], 21%\u201330%) had evidence of disseminated TB by either urine assay. Of 243 participants with both urine TB-LAM and Ultra results, 20% (48 of 243) were TB-LAM-positive, 12% (29 of 243) were Ultra-positive, and 6% (14 of 243) were positive by both assays. In definite and probable TB meningitis, 37% (14 of 38) were TB-LAM-positive and 41% (15 of 37) were Ultra-positive. In cryptococcal meningitis, 22% (40 of 183) were TB-LAM-positive and 4.4% (6 of 135) were Ultra-positive. Mortality trended higher in those with evidence of disseminated TB by either assay (odds ratio\u2005=\u20051.44; 95% CI, 0.83\u20132.49; P\u2005=\u2005.19) and was 6-fold higher in those with definite TB meningitis who were urine Ultra-positive (odds ratio\u2005=\u20055.67; 95% CI, 1.13\u201328.5; P\u2005=\u2005.04).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In hospitalized Ugandans with advanced HIV disease and suspected meningitis, systematic screening with urine TB-LAM and Ultra found a high prevalence of urine TB test positivity (26%). In those with TB meningitis, urine tests were positive in over one third. There was little concordance between Ultra and TB-LAM, which warrants further investigation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofaa100","type":"journal-article","created":{"date-parts":[[2020,3,24]],"date-time":"2020-03-24T03:47:53Z","timestamp":1585021673000},"source":"Crossref","is-referenced-by-count":37,"title":["Standardized Urine-Based Tuberculosis (TB) Screening With TB-Lipoarabinomannan and Xpert MTB\/RIF Ultra in Ugandan Adults With Advanced Human Immunodeficiency Virus Disease and Suspected Meningitis"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5070-532X","authenticated-orcid":false,"given":"Fiona V","family":"Cresswell","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"},{"name":"Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom"},{"name":"MRC-UVRI-London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7009-9144","authenticated-orcid":false,"given":"Jayne","family":"Ellis","sequence":"first","affiliation":[{"name":"Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enock","family":"Kagimu","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananta S","family":"Bangdiwala","sequence":"first","affiliation":[{"name":"Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Okirwoth","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Mugumya","sequence":"first","affiliation":[{"name":"Microbiology Laboratory, Kiruddu Referral Hospital, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morris","family":"Rutakingirwa","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kasibante","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carson M","family":"Quinn","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Ssebambulidde","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0480-9646","authenticated-orcid":false,"given":"Joshua","family":"Rhein","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"},{"name":"Division of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, Kansas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin","family":"Nuwagira","sequence":"first","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lillian","family":"Tugume","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Martyn","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caleb P","family":"Skipper","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"},{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conrad","family":"Muzoora","sequence":"first","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Grint","sequence":"first","affiliation":[{"name":"Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B","family":"Meya","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"},{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan C","family":"Bahr","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, Kansas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison M","family":"Elliott","sequence":"first","affiliation":[{"name":"Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom"},{"name":"MRC-UVRI-London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R","family":"Boulware","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of 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