{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T20:27:46Z","timestamp":1791145666295,"version":"4.1.0"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2011,5,1]],"date-time":"2011-05-01T00:00:00Z","timestamp":1304208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Mortality is exceedingly high and rapid among patients infected with HIV and tuberculosis (TB), in part because of limited access to appropriate TB diagnostics. The microscopic observation drug-susceptibility (MODS) assay is a simple, rapid, low-cost test for TB and multidrug-resistant (MDR) TB, but data in individuals infected with HIV and in Africa are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the MODS assay in a high-HIV-prevalence setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a prospective diagnostic accuracy study of consecutive adults suspected to have TB from outpatient and inpatient settings at a district hospital in rural South Africa. Sputum was tested by concentrated smear microscopy; agar (Middlebrook 7H11) and liquid (mycobacterial growth indicator tube) culture; and the MODS assay. Drug-susceptibility testing (DST) was by indirect 1% proportion method and MODS. Reference standard for Mycobacterium tuberculosis detection was growth on Middlebrook or mycobacterial growth indicator tube culture; 1% proportion was the reference standard for isoniazid and rifampin DST.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Among 534 adults enrolled, 388 (73%) were HIV-positive, with a median CD4 count of 161 cells\/mm3 (interquartile range [IQR]: 72\u2013307). TB was diagnosed by the reference standard culture in 113 (21%). MODS sensitivity was 85% (95% confidence interval [CI], 78\u201392%), and specificity was 97% (CI, 95\u201399%). MODS test performance did not differ by patients' HIV status (sensitivity 88% vs. 90%, specificity 97% vs. 100% for HIV-positive versus HIV-negative, respectively). For MDR-TB diagnosis (n = 11), sensitivity was 100% (one-sided CI, 68\u2013100%) and specificity was 94% (CI, 82\u201398%). Median turnaround time for MDR-TB diagnosis was 7 days (IQR: 6\u20139) with MODS versus 70 days (IQR: 49\u201396) with indirect proportion method (P &amp;lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among adult TB suspects predominantly infected with HIV, MODS provided high sensitivity and specificity for rapid diagnosis of TB and MDR-TB. Given the high mortality from TB and MDR-TB and prolonged opportunity for TB transmission before diagnosis, the MODS assay warrants serious consideration for use in similar high-HIV-prevalence, resource-limited settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201009-1449oc","type":"journal-article","created":{"date-parts":[[2011,2,4]],"date-time":"2011-02-04T22:37:28Z","timestamp":1296859048000},"page":"1427-1433","source":"Crossref","is-referenced-by-count":44,"title":["Rapid Diagnosis of Tuberculosis and Multidrug Resistance by the Microscopic-Observation Drug-Susceptibility Assay"],"prefix":"10.1093","volume":"183","author":[{"given":"N. Sarita","family":"Shah","sequence":"first","affiliation":[{"name":"Tugela Ferry Care and Research Collaboration, Tugela Ferry, South Africa"},{"name":"Albert Einstein College of Medicine and Montefiore Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashini","family":"Moodley","sequence":"additional","affiliation":[{"name":"Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Palav","family":"Babaria","sequence":"additional","affiliation":[{"name":"Tugela Ferry Care and Research Collaboration, Tugela Ferry, South Africa"},{"name":"Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salona","family":"Moodley","sequence":"additional","affiliation":[{"name":"Nelson R. 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