{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T21:33:12Z","timestamp":1768339992295,"version":"3.49.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,8,14]],"date-time":"2022-08-14T00:00:00Z","timestamp":1660435200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007137","name":"Helse Nord RHF","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007137","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Foundation For Innovative New Diagnostics"},{"DOI":"10.13039\/100010269","name":"Wellcome","doi-asserted-by":"publisher","award":["WT200901"],"award-info":[{"award-number":["WT200901"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome","doi-asserted-by":"publisher","award":["206575\/Z\/17\/Z"],"award-info":[{"award-number":["206575\/Z\/17\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>TB is a leading cause of morbidity among HIV positive individuals. Accurate algorithms are needed to achieve early TB diagnosis and treatment. We investigated the use of Xpert MTB\/RIF Ultra in combination with chest radiography for TB diagnosis in ambulatory HIV positive individuals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a randomised controlled trial with a 2-by-2 factorial design. Outpatient HIV clinic attendees with cough were randomised to four arms: Arm 1\u2014Standard Xpert\/no chest radiography (CXR); Arm 2\u2014Standard Xpert\/CXR; Arm 3\u2014Xpert Ultra\/no CXR; and Arm 4\u2014Xpert Ultra\/CXR. Participants were followed up at days 28 and 56 to assess for TB treatment initiation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We randomised 640 participants. Bacteriologically confirmed TB treatment initiation at day 28 were: Arm 1 (8.4% [14\/162]), Arm 2 (6.9% [11\/159]), Arm 3 (8.2% [13\/159]) and Arm 4 (5.6% [9\/160]) and between Xpert Ultra group (Arms 3 and 4) (6.9% [22\/319]) vs Standard Xpert group (Arms 1 and 2) (7.8% [25\/321]), risk ratio 0.89 (95% CI 0.51 to 1.54). By day 56, there were also similar all-TB treatment initiations in the x-ray group (Arms 2 and 4) (16.0% [51\/319]) compared with the no x-ray group (Arms 1 and 3) (13.1% [42\/321]), risk ratio 1.22 (95% CI 0.84 to 1.78); however, the contribution of clinically diagnosed treatment initiations were higher in x-ray groups (50.9% vs 19.0%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Xpert Ultra performed similarly to Xpert MTB\/RIF. X-rays are useful for TB screening but further research should investigate how to mitigate false-positive treatment initiations.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/trstmh\/trac079","type":"journal-article","created":{"date-parts":[[2022,8,14]],"date-time":"2022-08-14T02:07:02Z","timestamp":1660442822000},"page":"28-37","source":"Crossref","is-referenced-by-count":7,"title":["Utility of Xpert MTB\/RIF Ultra and digital chest radiography for the diagnosis and treatment of TB in people living with HIV: a randomised controlled trial (XACT-TB)"],"prefix":"10.1093","volume":"117","author":[{"given":"Madalo","family":"Mukoka","sequence":"first","affiliation":[{"name":"Pathology Department, Helse Nord TB Initiative, Kamuzu University of Health Sciences , Private Bag 360, Blantyre , Malawi"},{"name":"Public Health Group, Malawi\u2013Liverpool\u2013Wellcome Trust Clinical Research Programme , P.O. Box 30096, Blantyre , Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hussein H","family":"Twabi","sequence":"additional","affiliation":[{"name":"Pathology Department, Helse Nord TB Initiative, Kamuzu University of Health Sciences , Private Bag 360, Blantyre , Malawi"},{"name":"Public Health Group, Malawi\u2013Liverpool\u2013Wellcome Trust Clinical Research Programme , P.O. Box 30096, Blantyre , Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chisomo","family":"Msefula","sequence":"additional","affiliation":[{"name":"Pathology Department, Helse Nord TB Initiative, Kamuzu University of Health Sciences , Private Bag 360, Blantyre , Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robina","family":"Semphere","sequence":"additional","affiliation":[{"name":"Pathology Department, Helse Nord TB Initiative, Kamuzu University of Health Sciences , Private Bag 360, Blantyre , Malawi"},{"name":"Public Health Group, Malawi\u2013Liverpool\u2013Wellcome Trust Clinical Research Programme , P.O. Box 30096, Blantyre , Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel","family":"Ndhlovu","sequence":"additional","affiliation":[{"name":"Pathology Department, Helse Nord TB Initiative, Kamuzu University of Health Sciences , Private Bag 360, Blantyre , Malawi"},{"name":"Public Health Group, Malawi\u2013Liverpool\u2013Wellcome Trust Clinical Research Programme , P.O. Box 30096, Blantyre , Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trancizeo","family":"Lipenga","sequence":"additional","affiliation":[{"name":"Pathology Department, Helse Nord TB Initiative, Kamuzu University of Health Sciences , Private Bag 360, Blantyre , Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tionge Daston","family":"Sikwese","sequence":"additional","affiliation":[{"name":"Pathology Department, Helse Nord TB Initiative, Kamuzu University of Health Sciences , Private Bag 360, Blantyre , Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Malisita","sequence":"additional","affiliation":[{"name":"Lighthouse Umodzi centre, Queen Elizabeth Central Hospital , P.O. Box 95, Blantyre , Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Augustine","family":"Choko","sequence":"additional","affiliation":[{"name":"Public Health Group, Malawi\u2013Liverpool\u2013Wellcome Trust Clinical Research Programme , P.O. Box 30096, Blantyre , Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth L","family":"Corbett","sequence":"additional","affiliation":[{"name":"Public Health Group, Malawi\u2013Liverpool\u2013Wellcome Trust Clinical Research Programme , P.O. Box 30096, Blantyre , Malawi"},{"name":"Clinical Research Department, London School of Hygiene and Tropical Medicine , London, WC1E 7HT , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0329-9613","authenticated-orcid":false,"given":"Peter","family":"MacPherson","sequence":"additional","affiliation":[{"name":"Public Health Group, Malawi\u2013Liverpool\u2013Wellcome Trust Clinical Research Programme , P.O. 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