{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T03:16:21Z","timestamp":1779246981158,"version":"3.51.4"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2019,3,1]],"date-time":"2019-03-01T00:00:00Z","timestamp":1551398400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000060","name":"NIH\/National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K23 AI114363, C.Y."],"award-info":[{"award-number":["K23 AI114363, C.Y."]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"San Francisco Gladstone Institute of Virology and Immunology Center for AIDS Research","award":["P30 AI027763, C.Y."],"award-info":[{"award-number":["P30 AI027763, C.Y."]}]},{"name":"San Francisco Nina Ireland Program for Lung Health"},{"name":"NIH\/National Institute of Allergy and Infectious Diseases Presidential Emergency Plan for AIDS Relief Center for AIDS Research Administrative Supplement","award":["P30 A120163, A.C."],"award-info":[{"award-number":["P30 A120163, A.C."]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,3,1]]},"abstract":"Abstract<\/jats:title>\n \n Rationale<\/jats:title>\n The recommended tuberculosis (TB) intensified case finding (ICF) algorithm for people living with HIV (symptom-based screening followed by Xpert MTB\/RIF [Xpert] testing) is insufficiently sensitive and results in unnecessary Xpert testing.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To evaluate whether novel ICF algorithms combining C-reactive protein (CRP)-based screening with urine Determine TB-LAM (TB-LAM), sputum Xpert, and\/or sputum culture could improve ICF yield and efficiency.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We compared the yield and efficiency of novel ICF algorithms inclusive of point-of-care CRP-based TB screening and confirmatory testing with urine TB-LAM (if CD4 count \u2264100 cells\/\u03bcl), sputum Xpert, and\/or a single sputum culture among consecutive people living with HIV with CD4 counts less than or equal to 350 cells\/\u03bcl initiating antiretroviral therapy in Uganda.<\/jats:p>\n <\/jats:sec>\n \n Measurements and Main Results<\/jats:title>\n Of 1,245 people living with HIV, 203 (16%) had culture-confirmed TB including 101 (49%) patients with CD4 counts less than or equal to 100 cells\/\u03bcl. Compared with the current ICF algorithm, point-of-care CRP-based TB screening followed by Xpert testing had similar yield (56% [95% confidence interval, 49\u201363] vs. 59% [95% confidence interval, 51\u201365]) but consumed less than half as many Xpert assays per TB case detected (9 vs. 4). Addition of TB-LAM did not significantly increase diagnostic yield relative to the current ICF algorithm but provided same-day diagnosis for 26% of TB patients with advanced HIV. Addition of a single culture to TB-LAM and Xpert substantially improved ICF yield, identifying 78% of all TB cases.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Point-of-care CRP-based screening can improve ICF efficiency among people living with HIV. Addition of TB-LAM and a single culture to Xpert confirmatory testing could enable HIV programs to increase the speed of TB diagnosis and ICF yield.<\/jats:p>\n <\/jats:sec>","DOI":"10.1164\/rccm.201803-0490oc","type":"journal-article","created":{"date-parts":[[2018,9,7]],"date-time":"2018-09-07T16:35:46Z","timestamp":1536338146000},"page":"643-650","source":"Crossref","is-referenced-by-count":37,"title":["Yield and Efficiency of Novel Intensified Tuberculosis Case-Finding Algorithms for People Living with HIV"],"prefix":"10.1093","volume":"199","author":[{"given":"Christina","family":"Yoon","sequence":"first","affiliation":[{"name":"Division of Pulmonary & Critical Care Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fred C.","family":"Semitala","sequence":"additional","affiliation":[{"name":"Department of Medicine, Makerere University College of Health Sciences, Kampala, 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