{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:58:28Z","timestamp":1790791108132,"version":"4.1.0"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["104803"],"award-info":[{"award-number":["104803"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CIDRI-Africa","id":[{"id":"https:\/\/ror.org\/040b19m18","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Systematic screening for tuberculosis (TB) is recommended in people with diabetes; however, data on the accuracy of screening tools in this population are lacking. We assessed the accuracy of symptom and chest X-ray screening among people with diabetes. We consecutively enrolled adults with diabetes attending routine care in South Africa. All participants underwent symptom screening and chest X-ray. A single sputum specimen was collected from all participants and tested by Xpert Ultra. A positive Xpert Ultra result was used as the reference standard. We enrolled 673 participants. The median age was 54 years (interquartile range 47\u201360 years), and 63.8% were female. HIV prevalence was 17.2%. Prevalent TB was diagnosed in nine participants (1.33%). Any cough had a sensitivity of 22.2% (95% confidence interval [CI] 2.1-60.0%) and a specificity of 97.5% (95%CI 96.0-98.6%). Expanding the symptom definition to include any of cough, fever, weight loss, or night sweats did not improve sensitivity (22.2%, 95% CI 2.1\u201360.0) and slightly reduced specificity to 96.0% (95% CI 94.2\u201397.0). Chest X-ray abnormalities suggestive of TB demonstrated a sensitivity of 55.6% (95%CI 21.2-86.3%) and a specificity of 95.4% (95%CI 93.4-97.0%). The specificity of chest X-ray was significantly lower in participants with prior TB (87.6%, 95% CI: 79.8\u201390.6%), compared to 97.2% (95% CI: 95.2\u201398.5%) in those without (p\u2009&lt;\u20090.01). Symptom-based TB screening has poor sensitivity in people with diabetes. Although chest X-ray improved the sensitivity, it remained suboptimal, with a reduced specificity in people with previous TB.<\/jats:p>","DOI":"10.1371\/journal.pgph.0006479","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:31:01Z","timestamp":1790789461000},"page":"e0006479","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sensitivity and specificity of tuberculosis screening tools in people with diabetes"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3931-5460","authenticated-orcid":true,"given":"Neha","family":"Janrode","sequence":"first","affiliation":[{"name":"University College London","place":["London, United Kingdom"],"department":["Institute for Global Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9845-4267","authenticated-orcid":true,"given":"Yohhei","family":"Hamada","sequence":"additional","affiliation":[{"name":"University College London","place":["London, United Kingdom"],"department":["Institute for Global Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arshad","family":"Taliep","sequence":"additional","affiliation":[{"name":"University of Cape Town","place":["Cape Town, South Africa"],"department":["Wellcome Discovery Research Platforms for Infection, Institute of Infectious Disease and Molecular Medicine and Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Barron","sequence":"additional","affiliation":[{"name":"University of Cape Town","place":["Cape Town, South Africa"],"department":["Wellcome Discovery Research Platforms for Infection, Institute of Infectious Disease and Molecular Medicine and Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2716-7117","authenticated-orcid":true,"given":"Walter","family":"Chabaya","sequence":"additional","affiliation":[{"name":"University of Cape Town","place":["Cape Town, South Africa"],"department":["Wellcome Discovery Research Platforms for Infection, Institute of Infectious Disease and Molecular Medicine and Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene T.","family":"Goliath","sequence":"additional","affiliation":[{"name":"University of Cape Town","place":["Cape Town, South Africa"],"department":["Wellcome Discovery Research Platforms for Infection, Institute of Infectious Disease and Molecular Medicine and Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1328-1310","authenticated-orcid":true,"given":"Trinh","family":"Duong","sequence":"additional","affiliation":[{"name":"Institute of Clinical Trials and Methodology","place":["London, United Kingdom"],"department":["MRC Clinical Trials Unit at UCL"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Jackson","sequence":"additional","affiliation":[{"name":"University of Cape Town","place":["Cape Town, South Africa"],"department":["Wellcome Discovery Research Platforms for Infection, Institute of Infectious Disease and Molecular Medicine and Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shireen","family":"Galant","sequence":"additional","affiliation":[{"name":"University of Cape Town","place":["Cape Town, South Africa"],"department":["Wellcome Discovery Research Platforms for Infection, Institute of Infectious Disease and Molecular Medicine and Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nashreen","family":"Omar-Davies","sequence":"additional","affiliation":[{"name":"University of Cape Town","place":["Cape Town, South Africa"],"department":["Wellcome Discovery Research Platforms for Infection, Institute of Infectious Disease and Molecular Medicine and Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise Lai","family":"Sai","sequence":"additional","affiliation":[{"name":"University of Cape Town","place":["Cape Town, South Africa"],"department":["Wellcome Discovery Research Platforms for Infection, Institute of Infectious Disease and Molecular Medicine and Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lillian","family":"Twentiey","sequence":"additional","affiliation":[{"name":"University of Cape Town","place":["Cape Town, South Africa"],"department":["Wellcome 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Global Health"]},{"name":"University of Cape Town","place":["Cape Town, South Africa"],"department":["Wellcome Discovery Research Platforms for Infection, Institute of Infectious Disease and Molecular Medicine and Department of Medicine"]},{"name":"University of Cape Town","place":["Cape Town, South Africa"],"department":["School of Public Health and Clinical Infectious Disease Research Institute-AFRICA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"pgph.0006479.ref001","volume-title":"Global TB Report","author":"World Health Organization","year":"2024"},{"issue":"11","key":"pgph.0006479.ref002","article-title":"Association between diabetes mellitus and active tuberculosis: A systematic review and meta-analysis","volume":"12","author":"RH Al-Rifai","year":"2017","journal-title":"PLoS 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