{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T04:58:00Z","timestamp":1775192280970,"version":"3.50.1"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000009","name":"Foundation for the National Institutes of Health","doi-asserted-by":"publisher","award":["R01HL153611"],"award-info":[{"award-number":["R01HL153611"]}],"id":[{"id":"10.13039\/100000009","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000009","name":"Foundation for the National Institutes of Health","doi-asserted-by":"publisher","award":["T32AI007291"],"award-info":[{"award-number":["T32AI007291"]}],"id":[{"id":"10.13039\/100000009","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000009","name":"Foundation for the National Institutes of Health","doi-asserted-by":"publisher","award":["K23AI185268"],"award-info":[{"award-number":["K23AI185268"]}],"id":[{"id":"10.13039\/100000009","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-042921"],"award-info":[{"award-number":["INV-042921"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infect Dis Poverty"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>A \u201ctrace\u201d result from the Xpert Ultra molecular tuberculosis test indicates <jats:italic>Mycobacterium tuberculosis<\/jats:italic> DNA detection but may not always signify tuberculosis disease. Little is known about the experiences of individuals with trace results who are not immediately treated. We surveyed patients with trace results to better understand their experiences and preferences related to their uncertain tuberculosis status.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We enrolled adults and adolescents with trace Xpert Ultra sputum results, plus individuals with positive (at a semiquantitative level greater than trace) results (\u201cpositive controls\u201d) and with negative results (\u201cnegative controls\u201d), from community-screening and clinic settings in Kampala, Uganda\u00a0between February 2021 and December 2024. After an extensive clinical, laboratory, and radiographic evaluation, participants not recommended to start tuberculosis treatment immediately were closely monitored with interval reassessments. Starting in September 2021, surveys captured participants\u2019 perceptions and preferences related to their uncertain tuberculosis status at baseline and one and six months later. We compared categorial variables using Pearson\u2019s chi-squared test or Fisher\u2019s exact test with a significance level of 0.05.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total of 329 people with trace sputum (PWTS), 241 positive controls, and 279 negative controls were enrolled. Among PWTS surveyed, 22% (28\/129) and 23% (30\/129) thought they were likely to have or develop tuberculosis, respectively, and most reported low associated anxiety initially (80%, 263\/329) and during follow-up. While 53% (174\/329) would have favored treatment at baseline if not in the study, only 30% (41\/136) of those who remained untreated were inclined toward treatment at six months. Participants chose a sensitive hypothetical test, even with high false-positivity risk, over one with lower sensitivity.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Most PWTS in our study reported a low self-perceived likelihood of having or developing tuberculosis and low anxiety during follow up. Deferring treatment for PWTS is acceptable to most patients when sufficient testing and monitoring are available; in other contexts, upfront treatment may be preferable.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1186\/s40249-025-01338-0","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T09:18:17Z","timestamp":1752571097000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Patient experiences of tuberculosis treatment deferral after a trace Xpert Ultra result: a prospective cohort study"],"prefix":"10.1186","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5132-2092","authenticated-orcid":false,"given":"Caitlin","family":"Visek","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Mukiibi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariam","family":"Nantale","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annet","family":"Nalutaaya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Bich\u00e9","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joowhan","family":"Sung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis","family":"Kayondo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joab","family":"Akampurira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Mukiibi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rogers","family":"Kiyonga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Achilles","family":"Katamba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily A.","family":"Kendall","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"issue":"4","key":"1338_CR1","doi-asserted-by":"publisher","first-page":"e00812","DOI":"10.1128\/mBio.00812-17","volume":"8","author":"S Chakravorty","year":"2017","unstructured":"Chakravorty S, Simmons A, Rowneki M, Parmar H, Cao Y, Ryan J, et al. The new Xpert MTB\/RIF Ultra: improving detection of Mycobacterium tuberculosis and resistance to rifampin in an assay suitable for point-of-care testing. MBio. 2017;8(4):e00812-e817.","journal-title":"MBio"},{"issue":"12","key":"1338_CR2","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1128\/JCM.00560-18","volume":"56","author":"RH Berhanu","year":"2018","unstructured":"Berhanu RH, David A, da Silva P, Shearer K, Sanne I, Stevens W, et al. Performance of Xpert MTB\/RIF, Xpert Ultra, and Abbott RealTime MTB for diagnosis of pulmonary tuberculosis in a high-HIV-burden setting. J Clin Microbiol. 2018;56(12):10.","journal-title":"J Clin Microbiol"},{"issue":"1","key":"1338_CR3","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/S1473-3099(17)30691-6","volume":"18","author":"SE Dorman","year":"2018","unstructured":"Dorman SE, Schumacher SG, Alland D, Nabeta P, Armstrong DT, King B, et al. Xpert MTB\/RIF Ultra for detection of Mycobacterium tuberculosis and rifampicin resistance: a prospective multicentre diagnostic accuracy study. Lancet Infect Dis. 2018;18(1):76\u201384.","journal-title":"Lancet Infect Dis"},{"key":"1338_CR4","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1016\/j.ijid.2020.03.025","volume":"95","author":"A Esmail","year":"2020","unstructured":"Esmail A, Tomasicchio M, Meldau R, Makambwa E, Dheda K. Comparison of Xpert MTB\/RIF (G4) and Xpert Ultra, including trace readouts, for the diagnosis of pulmonary tuberculosis in a TB and HIV endemic setting. Int J Infect Dis. 2020;95:246\u201352.","journal-title":"Int J Infect Dis"},{"issue":"6","key":"1338_CR5","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-058195","volume":"12","author":"S Floyd","year":"2022","unstructured":"Floyd S, Klinkenberg E, de Haas P, Kosloff B, Gachie T, Dodd PJ, et al. Optimising Xpert-Ultra and culture testing to reliably measure tuberculosis prevalence in the community: findings from surveys in Zambia and South Africa. BMJ Open. 2022;12(6): e058195.","journal-title":"BMJ Open"},{"key":"1338_CR6","volume-title":"WHO operational handbook on tuberculosis: module 3: diagnosis\u2014rapid diagnostics for tuberculosis detection","author":"World Health Organization","year":"2021","unstructured":"World Health Organization. WHO operational handbook on tuberculosis: module 3: diagnosis\u2014rapid diagnostics for tuberculosis detection. Geneva: World Health Organization; 2021."},{"issue":"11","key":"1338_CR7","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1002\/pds.5513","volume":"31","author":"H Choi","year":"2022","unstructured":"Choi H, Park HA, Hyun IG, Kim JH, Hwang YI, Jang SH, et al. 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Xpert MTB\/RIF Ultra and Xpert MTB\/RIF for diagnosis of tuberculosis in an HIV-endemic setting with a high burden of previous tuberculosis: a two-cohort diagnostic accuracy study. Lancet Respir Med. 2020;8(4):368\u201382.","journal-title":"Lancet Respir Med"},{"key":"1338_CR19","doi-asserted-by":"publisher","DOI":"10.1101\/2025.03.20.25324205","author":"J Sung","year":"2025","unstructured":"Sung J, Nantale M, Nalutaaya A, Bich\u00e9 P, Mukiibi J, Akampurira J, et al. The long-term risk of tuberculosis among individuals with Xpert Ultra \u201ctrace\u201d screening results: a longitudinal follow-up study. medRxiv. 2025. https:\/\/doi.org\/10.1101\/2025.03.20.25324205.","journal-title":"medRxiv"},{"issue":"6","key":"1338_CR20","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1093\/inthealth\/ihad002","volume":"15","author":"ML de Rooij","year":"2023","unstructured":"de Rooij ML, Lynen L, Decroo T, Henriquez-Trujillo AR, Boyles T, Jacobs BKM. The therapeutic threshold in clinical decision-making for TB. Int Health. 2023;15(6):615\u201322.","journal-title":"Int Health"}],"container-title":["Infectious Diseases of Poverty"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40249-025-01338-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40249-025-01338-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40249-025-01338-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T10:18:08Z","timestamp":1757240288000},"score":1,"resource":{"primary":{"URL":"https:\/\/idpjournal.biomedcentral.com\/articles\/10.1186\/s40249-025-01338-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,15]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1338"],"URL":"https:\/\/doi.org\/10.1186\/s40249-025-01338-0","relation":{},"ISSN":["2049-9957"],"issn-type":[{"value":"2049-9957","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,15]]},"assertion":[{"value":"3 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Makerere University School of Public Health Research and Ethics Committee (Protocol 901) and the Johns Hopkins Medicine Institutional Review Board (IRB00269370). Informed consent was obtained from all participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"68"}}