{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T17:37:25Z","timestamp":1793813845802,"version":"4.6.1"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U01AI152087"],"award-info":[{"award-number":["U01AI152087"]}],"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":["U01AI152087"],"award-info":[{"award-number":["U01AI152087"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>C-reactive protein (CRP)-based tuberculosis (TB) screening is recommended for people with HIV. However, its performance among people without HIV and in diverse settings is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>In a multicountry study, we aimed to determine whether CRP meets the minimum accuracy targets (sensitivity\u2009\u2a7e\u200990%, specificity\u2009\u2a7e\u200970%) for an effective TB screening test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive outpatient adults with cough \u2a7e2 weeks from five TB endemic countries in Africa and Asia had baseline blood collected for point-of-care CRP testing and HIV and diabetes screening. Sputum samples were collected for Xpert MTB\/RIF Ultra (Xpert) testing and culture. CRP sensitivity and specificity (5 mg\/L cut-point) was determined in reference to sputum test results and compared by country, sex, and HIV and diabetes status. Variables affecting CRP performance were identified using a multivariate receiver operating curve regression model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Among 2,904 participants, of whom 613 (21%) had microbiologically confirmed TB, CRP sensitivity was 84% (95% confidence interval [CI], 81\u201387%) and specificity was 61% (95% CI, 59\u201363%). CRP accuracy varied geographically, with higher sensitivity in African countries (\u2a7e91%) than Asian countries (64\u201382%). Sensitivity was higher among men than women (86% vs. 78%; difference, +8%; 95% CI, 1\u201315%) and specificity was lower among people with HIV than people without HIV (64% vs. 45%; difference, +19%; 95% CI, 13\u201325%). Receiver operating curve regression identified country and measures of TB disease severity as predictors of CRP performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall, CRP did not achieve the minimum accuracy targets, and its performance varied by setting and in some subgroups, likely reflecting population differences in mycobacterial load.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202405-1000oc","type":"journal-article","created":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T16:42:31Z","timestamp":1733503351000},"page":"499-506","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":9,"title":["C-Reactive Protein\u2013based Screening of People with Tuberculosis Symptoms: A Diagnostic Accuracy Study"],"prefix":"10.1093","volume":"211","author":[{"given":"Brigitta","family":"Derendinger","sequence":"first","affiliation":[{"name":"Department of Science and Technology-National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3220-004X","authenticated-orcid":false,"given":"Tessa K.","family":"Mochizuki","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, and"},{"name":"University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danaida","family":"Marcelo","sequence":"additional","affiliation":[{"name":"De La Salle Medical Health Sciences Institute, Dasmari\u00f1as City, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepa","family":"Shankar","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Christian Medical College, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson","family":"Mangeni","sequence":"additional","affiliation":[{"name":"Walimu and Makerere, University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanh","family":"Nguyen","sequence":"additional","affiliation":[{"name":"National Lung Hospital, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6064-548X","authenticated-orcid":false,"given":"Seda","family":"Yerikaya","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, German Center of Infection Research, partner site Heidelberg, Heidelberg, Germany; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Worodria","sequence":"additional","affiliation":[{"name":"Walimu and Makerere, University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Yu","sequence":"additional","affiliation":[{"name":"De La Salle Medical Health Sciences Institute, Dasmari\u00f1as City, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nhung Viet","family":"Nguyen","sequence":"additional","affiliation":[{"name":"National Lung Hospital, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devasahayam Jesudas","family":"Christopher","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Christian Medical College, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"Theron","sequence":"additional","affiliation":[{"name":"Department of Science and Technology-National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6336-7024","authenticated-orcid":false,"given":"Patrick P. 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