{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T15:04:19Z","timestamp":1779375859700,"version":"3.53.1"},"update-to":[{"DOI":"10.1371\/journal.pmed.1003739","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,9,21]],"date-time":"2021-09-21T00:00:00Z","timestamp":1632182400000}}],"reference-count":79,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T00:00:00Z","timestamp":1630972800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100009054","name":"U.S. President\u2019s Emergency Plan for AIDS Relief","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Among people living with HIV (PLHIV), more flexible and sensitive tuberculosis (TB) screening tools capable of detecting both symptomatic and subclinical active TB are needed to (1) reduce morbidity and mortality from undiagnosed TB; (2) facilitate scale-up of tuberculosis preventive therapy (TPT) while reducing inappropriate prescription of TPT to PLHIV with subclinical active TB; and (3) allow for differentiated HIV\u2013TB care.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>We used Botswana XPRES trial data for adult HIV clinic enrollees collected during 2012 to 2015 to develop a parsimonious multivariable prognostic model for active prevalent TB using both logistic regression and random forest machine learning approaches. A clinical score was derived by rescaling final model coefficients. The clinical score was developed using southern Botswana XPRES data and its accuracy validated internally, using northern Botswana data, and externally using 3 diverse cohorts of antiretroviral therapy (ART)-naive and ART-experienced PLHIV enrolled in XPHACTOR, TB Fast Track (TBFT), and Gugulethu studies from South Africa (SA). Predictive accuracy of the clinical score was compared with the World Health Organization (WHO) 4-symptom TB screen. Among 5,418 XPRES enrollees, 2,771 were included in the derivation dataset; 67% were female, median age was 34 years, median CD4 was 240 cells\/\u03bcL, 189 (7%) had undiagnosed prevalent TB, and characteristics were similar between internal derivation and validation datasets. Among XPHACTOR, TBFT, and Gugulethu cohorts, median CD4 was 400, 73, and 167 cells\/\u03bcL, and prevalence of TB was 5%, 10%, and 18%, respectively. Factors predictive of TB in the derivation dataset and selected for the clinical score included male sex (1 point), \u22651 WHO TB symptom (7 points), smoking history (1 point), temperature &gt;37.5\u00b0C (6 points), body mass index (BMI) &lt;18.5kg\/m<jats:sup>2<\/jats:sup> (2 points), and severe anemia (hemoglobin &lt;8g\/dL) (3 points). Sensitivity using WHO 4-symptom TB screen was 73%, 80%, 94%, and 94% in XPRES, XPHACTOR, TBFT, and Gugulethu cohorts, respectively, but increased to 88%, 87%, 97%, and 97%, when a clinical score of \u22652 was used. Negative predictive value (NPV) also increased 1%, 0.3%, 1.6%, and 1.7% in XPRES, XPHACTOR, TBFT, and Gugulethu cohorts, respectively, when the clinical score of \u22652 replaced WHO 4-symptom TB screen. Categorizing risk scores into low (&lt;2), moderate (2 to 10), and high-risk categories (&gt;10) yielded TB prevalence of 1%, 1%, 2%, and 6% in the lowest risk group and 33%, 22%, 26%, and 32% in the highest risk group for XPRES, XPHACTOR, TBFT, and Gugulethu cohorts, respectively. At clinical score \u22652, the number needed to screen (NNS) ranged from 5.0 in Gugulethu to 11.0 in XPHACTOR. Limitations include that the risk score has not been validated in resource-rich settings and needs further evaluation and validation in contemporary cohorts in Africa and other resource-constrained settings.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The simple and feasible clinical score allowed for prioritization of sensitivity and NPV, which could facilitate reductions in mortality from undiagnosed TB and safer administration of TPT during proposed global scale-up efforts. Differentiation of risk by clinical score cutoff allows flexibility in designing differentiated HIV\u2013TB care to maximize impact of available resources.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pmed.1003739","type":"journal-article","created":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T17:57:10Z","timestamp":1631037430000},"page":"e1003739","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Derivation and external validation of a risk score for predicting HIV-associated tuberculosis to support case finding and preventive therapy scale-up: A cohort study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5089-9163","authenticated-orcid":true,"given":"Andrew F.","family":"Auld","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5023-6658","authenticated-orcid":true,"given":"Andrew D.","family":"Kerkhoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1677-0697","authenticated-orcid":true,"given":"Yasmeen","family":"Hanifa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4276-7117","authenticated-orcid":true,"given":"Robin","family":"Wood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7143-1009","authenticated-orcid":true,"given":"Salome","family":"Charalambous","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuliang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1848-7307","authenticated-orcid":true,"given":"Tefera","family":"Agizew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2464-843X","authenticated-orcid":true,"given":"Anikie","family":"Mathoma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosanna","family":"Boyd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Date","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ray W.","family":"Shiraishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Bicego","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8514-1133","authenticated-orcid":true,"given":"Unami","family":"Mathebula-Modongo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Alexander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Serumola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Goabaone","family":"Rankgoane-Pono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6912-8086","authenticated-orcid":true,"given":"Pontsho","family":"Pono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7597-2395","authenticated-orcid":true,"given":"Alyssa","family":"Finlay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James C.","family":"Shepherd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3985-8330","authenticated-orcid":true,"given":"Tedd V.","family":"Ellerbrock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2437-5195","authenticated-orcid":true,"given":"Alison D.","family":"Grant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6524-3754","authenticated-orcid":true,"given":"Katherine","family":"Fielding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,9,7]]},"reference":[{"key":"pmed.1003739.ref001","unstructured":"World Health Organization. TB and HIV, and other comorbidities\u20142018 report. [cited 2020 Jun 3]. Available from: https:\/\/www.who.int\/tb\/areas-of-work\/tb-hiv\/en\/."},{"issue":"15","key":"pmed.1003739.ref002","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1097\/QAD.0000000000000802","article-title":"Prevalence of tuberculosis in post-mortem studies of HIV-infected adults and children in resource-limited settings: a systematic review and meta-analysis","volume":"29","author":"RK Gupta","year":"2015","journal-title":"AIDS"},{"issue":"12","key":"pmed.1003739.ref003","doi-asserted-by":"crossref","first-page":"e28691","DOI":"10.1371\/journal.pone.0028691","article-title":"Early Mortality in Adults Initiating Antiretroviral Therapy (ART) in Low- and Middle-Income Countries (LMIC): A Systematic Review and Meta-Analysis","volume":"6","author":"A Gupta","year":"2011","journal-title":"PLoS ONE"},{"key":"pmed.1003739.ref004","unstructured":"World Health Organization. Latent TB Infection: Updated and consolidated guidelines for programmatic management. [cited 30 Aug 2018]. Available from: http:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/260233\/9789241550239-eng.pdf?sequence=1."},{"issue":"4","key":"pmed.1003739.ref005","doi-asserted-by":"crossref","DOI":"10.1128\/CMR.00021-18","article-title":"Incipient and Subclinical Tuberculosis: a Clinical Review of Early Stages and Progression of Infection","volume":"31","author":"PK Drain","year":"2018","journal-title":"Clin Microbiol Rev"},{"issue":"9","key":"pmed.1003739.ref006","doi-asserted-by":"crossref","first-page":"e515","DOI":"10.1016\/S2352-3018(18)30137-1","article-title":"Sensitivity and specificity of WHO\u2019s recommended four-symptom screening rule for tuberculosis in people living with HIV: a systematic review and meta-analysis","volume":"5","author":"Y Hamada","year":"2018","journal-title":"Lancet HIV"},{"issue":"10","key":"pmed.1003739.ref007","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1097\/QAD.0000000000000278","article-title":"Performance of symptom-based tuberculosis screening among people living with HIV: not as great as hoped","volume":"28","author":"F Ahmad Khan","year":"2014","journal-title":"AIDS"},{"issue":"12","key":"pmed.1003739.ref008","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1093\/cid\/cis775","article-title":"Effect of antiretroviral therapy on the diagnostic accuracy of symptom screening for intensified tuberculosis case finding in a South African HIV clinic","volume":"55","author":"MX Rangaka","year":"2012","journal-title":"Clin Infect Dis"},{"issue":"12","key":"pmed.1003739.ref009","doi-asserted-by":"crossref","first-page":"329","DOI":"10.15585\/mmwr.mm6912a3","article-title":"Tuberculosis Preventive Treatment Scale-Up Among Antiretroviral Therapy Patients\u201416 Countries Supported by the U.S. President\u2019s Emergency Plan for AIDS Relief, 2017\u20132019","volume":"69","author":"M Melgar","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"2","key":"pmed.1003739.ref010","doi-asserted-by":"crossref","first-page":"241","DOI":"10.5588\/ijtld.18.0207","article-title":"Challenges and opportunities to prevent tuberculosis in people living with HIV in low-income countries","volume":"23","author":"AD Harries","year":"2019","journal-title":"Int J Tuberc Lung Dis"},{"issue":"6","key":"pmed.1003739.ref011","doi-asserted-by":"crossref","first-page":"596","DOI":"10.5588\/ijtld.17.0758","article-title":"TB preventive therapy for people living with HIV: key considerations for scale-up in resource-limited settings","volume":"22","author":"I Pathmanathan","year":"2018","journal-title":"Int J Tuberc Lung Dis"},{"issue":"7","key":"pmed.1003739.ref012","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1164\/rccm.200709-1311PP","article-title":"Immune reconstitution and \"unmasking\" of tuberculosis during antiretroviral therapy","volume":"177","author":"SD Lawn","year":"2008","journal-title":"Am J Respir Crit Care Med"},{"issue":"8","key":"pmed.1003739.ref013","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1136\/thx.2011.160168","article-title":"High prevalence of subclinical tuberculosis in HIV-1-infected persons without advanced immunodeficiency: implications for TB screening","volume":"66","author":"T Oni","year":"2011","journal-title":"Thorax"},{"issue":"1","key":"pmed.1003739.ref014","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/COH.0b013e328333850f","article-title":"Strategies to reduce early morbidity and mortality in adults receiving antiretroviral therapy in resource-limited settings","volume":"5","author":"SD Lawn","year":"2010","journal-title":"Curr Opin HIV AIDS"},{"issue":"1","key":"pmed.1003739.ref015","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1186\/s12879-016-1905-4","article-title":"Implementation of a pragmatic, stepped-wedge cluster randomized trial to evaluate impact of Botswana\u2019s Xpert MTB\/RIF diagnostic algorithm on TB diagnostic sensitivity and early antiretroviral therapy mortality","volume":"16","author":"AF Auld","year":"2016","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pmed.1003739.ref016","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s12916-019-1489-0","article-title":"Effect of tuberculosis screening and retention interventions on early antiretroviral therapy mortality in Botswana: a stepped-wedge cluster randomized trial","volume":"18","author":"AF Auld","year":"2020","journal-title":"BMC Med"},{"issue":"13","key":"pmed.1003739.ref017","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1056\/NEJMp1606181","article-title":"Predicting the Future\u2014Big Data, Machine Learning, and Clinical Medicine","volume":"375","author":"Z Obermeyer","year":"2016","journal-title":"N Engl J Med"},{"issue":"8","key":"pmed.1003739.ref018","doi-asserted-by":"crossref","first-page":"e0181519","DOI":"10.1371\/journal.pone.0181519","article-title":"A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa","volume":"12","author":"Y Hanifa","year":"2017","journal-title":"PLoS ONE"},{"key":"pmed.1003739.ref019","article-title":"Algorithm-guided empirical tuberculosis treatment for people with advanced HIV (TB Fast Track): an open-label, cluster-randomised trial","author":"AD Grant","year":"2019","journal-title":"Lancet HIV"},{"issue":"7","key":"pmed.1003739.ref020","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1086\/501018","article-title":"Impact of HIV infection on the epidemiology of tuberculosis in a peri-urban community in South Africa: the need for age-specific interventions","volume":"42","author":"SD Lawn","year":"2006","journal-title":"Clin Infect Dis"},{"key":"pmed.1003739.ref021","unstructured":"WHO. Tuberculosis Country Profiles. [cited 2021 Apr 10]. Avaiable from: https:\/\/www.who.int\/tb\/country\/data\/profiles\/en\/."},{"issue":"3","key":"pmed.1003739.ref022","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/S1473-3099(11)70251-1","article-title":"Diagnostic accuracy of a low-cost, urine antigen, point-of-care screening assay for HIV-associated pulmonary tuberculosis before antiretroviral therapy: a descriptive study","volume":"12","author":"SD Lawn","year":"2012","journal-title":"Lancet Infect Dis"},{"issue":"3","key":"pmed.1003739.ref023","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/QAI.0000000000000482","article-title":"Initial programmatic implementation of WHO option B in Botswana associated with increased projected MTCT","volume":"68","author":"S Dryden-Peterson","year":"2015","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pmed.1003739.ref024","doi-asserted-by":"crossref","first-page":"b605","DOI":"10.1136\/bmj.b605","article-title":"Prognosis and prognostic research: validating a prognostic model","volume":"338","author":"DG Altman","year":"2009","journal-title":"BMJ"},{"issue":"10","key":"pmed.1003739.ref025","first-page":"1231","article-title":"Prevalent infectious tuberculosis in Harare, Zimbabwe: burden, risk factors and implications for control","volume":"13","author":"EL Corbett","year":"2009","journal-title":"Int J Tuberc Lung Dis"},{"issue":"9","key":"pmed.1003739.ref026","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1097\/QAD.0b013e3283390dd1","article-title":"Tuberculosis during the first year of antiretroviral therapy in a South African cohort using an intensive pretreatment screening strategy","volume":"24","author":"SD Lawn","year":"2010","journal-title":"AIDS"},{"key":"pmed.1003739.ref027","doi-asserted-by":"crossref","first-page":"b604","DOI":"10.1136\/bmj.b604","article-title":"Prognosis and prognostic research: Developing a prognostic model","volume":"338","author":"P Royston","year":"2009","journal-title":"BMJ"},{"issue":"1","key":"pmed.1003739.ref028","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/QAI.0000000000000091","article-title":"Predictive value of anemia for tuberculosis in HIV-infected patients in Sub-Saharan Africa: an indication for routine microbiological investigation using new rapid assays","volume":"66","author":"AD Kerkhoff","year":"2014","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"1","key":"pmed.1003739.ref029","doi-asserted-by":"crossref","first-page":"e54665","DOI":"10.1371\/journal.pone.0054665","article-title":"Incidence and determinants of tuberculosis among adults initiating antiretroviral therapy\u2014Mozambique, 2004\u20132008","volume":"8","author":"AF Auld","year":"2013","journal-title":"PLoS ONE"},{"issue":"4","key":"pmed.1003739.ref030","first-page":"378","article-title":"HIV infection and tobacco smoking behaviour: prospects for prevention? ANRS CO3 Aquitaine Cohort, 2002","volume":"10","author":"A Benard","year":"2006","journal-title":"Int J Tuberc Lung Dis"},{"issue":"4","key":"pmed.1003739.ref031","first-page":"867","article-title":"Screening scheme development for active TB prediction among HIV-infected patients","volume":"42","author":"S Nanta","year":"2011","journal-title":"Southeast Asian J Trop Med Public Health"},{"issue":"3","key":"pmed.1003739.ref032","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofu095","article-title":"A Clinical Scoring Algorithm for Determination of the Risk of Tuberculosis in HIV-Infected Adults: A Cohort Study Performed at Ethiopian Health Centers","volume":"1","author":"TT Balcha","year":"2014","journal-title":"Open Forum Infect Dis"},{"issue":"1","key":"pmed.1003739.ref033","doi-asserted-by":"crossref","first-page":"e000262","DOI":"10.1136\/fmch-2019-000262","article-title":"Variable selection strategies and its importance in clinical prediction modelling","volume":"8","author":"MZI Chowdhury","year":"2020","journal-title":"Fam Med Community Health"},{"issue":"1","key":"pmed.1003739.ref034","doi-asserted-by":"crossref","first-page":"e0192030","DOI":"10.1371\/journal.pone.0192030","article-title":"Immunological non-response and low hemoglobin levels are predictors of incident tuberculosis among HIV-infected individuals on Truvada-based therapy in Botswana","volume":"13","author":"L Mupfumi","year":"2018","journal-title":"PLoS ONE"},{"issue":"480","key":"pmed.1003739.ref035","doi-asserted-by":"crossref","DOI":"10.1126\/scitranslmed.aau6242","article-title":"Estimating cholera incidence with cross-sectional serology","volume":"11","author":"AS Azman","year":"2019","journal-title":"Sci Transl Med"},{"issue":"4","key":"pmed.1003739.ref036","doi-asserted-by":"crossref","first-page":"e0174944","DOI":"10.1371\/journal.pone.0174944","article-title":"Can machine-learning improve cardiovascular risk prediction using routine clinical data?","volume":"12","author":"SF Weng","year":"2017","journal-title":"PLoS ONE"},{"key":"pmed.1003739.ref037","unstructured":"Zhou V. Random Forests for Complete Beginners. [cited 2021 Apr 10]. Available from: https:\/\/victorzhou.com\/blog\/intro-to-random-forests\/."},{"key":"pmed.1003739.ref038","doi-asserted-by":"crossref","first-page":"b606","DOI":"10.1136\/bmj.b606","article-title":"Prognosis and prognostic research: application and impact of prognostic models in clinical practice","volume":"338","author":"KG Moons","year":"2009","journal-title":"BMJ"},{"issue":"4","key":"pmed.1003739.ref039","doi-asserted-by":"crossref","first-page":"e1002776","DOI":"10.1371\/journal.pmed.1002776","article-title":"Risk score for predicting mortality including urine lipoarabinomannan detection in hospital inpatients with HIV-associated tuberculosis in sub-Saharan Africa: Derivation and external validation cohort study","volume":"16","author":"A Gupta-Wright","year":"2019","journal-title":"PLoS Med"},{"key":"pmed.1003739.ref040","unstructured":"Williams R. Standardized Coefficients in Logistic Regression. [cited 2021 Apr 12]. Available from: https:\/\/www3ndedu\/~rwilliam\/stats3\/L04pdf."},{"key":"pmed.1003739.ref041","unstructured":"World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. [cited 2020 Jun 1]. Available from: https:\/\/www.who.int\/vmnis\/indicators\/haemoglobin\/en\/."},{"key":"pmed.1003739.ref042","unstructured":"Del Bene VE. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Chapter 218Temperature. [cited 2019 Dec 31]. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK331\/."},{"issue":"2","key":"pmed.1003739.ref043","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofz543","article-title":"A Clinical Prediction Score Including Trial of Antibiotics and C-Reactive Protein to Improve the Diagnosis of Tuberculosis in Ambulatory People With HIV","volume":"7","author":"TH Boyles","year":"2020","journal-title":"Open Forum Infect Dis"},{"key":"pmed.1003739.ref044","doi-asserted-by":"crossref","first-page":"S78","DOI":"10.1016\/j.ijid.2020.03.012","article-title":"A clinical score has utility in tuberculosis case-finding among patients with HIV: A feasibility study from Bissau","volume":"92S","author":"JW Aunsborg","year":"2020","journal-title":"Int J Infect Dis"},{"issue":"3","key":"pmed.1003739.ref045","doi-asserted-by":"crossref","first-page":"277","DOI":"10.5588\/ijtld.13.0517","article-title":"Can tuberculosis case finding among health-care seeking adults be improved? Observations from Bissau","volume":"18","author":"F Rudolf","year":"2014","journal-title":"Int J Tuberc Lung Dis"},{"issue":"11","key":"pmed.1003739.ref046","doi-asserted-by":"crossref","first-page":"e1003420","DOI":"10.1371\/journal.pmed.1003420","article-title":"A clinical score for identifying active tuberculosis while awaiting microbiological results: Development and validation of a multivariable prediction model in sub-Saharan Africa","volume":"17","author":"Y Baik","year":"2020","journal-title":"PLoS Med"},{"key":"pmed.1003739.ref047","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/1472-6890-11-5","article-title":"Hemoglobin estimation by the HemoCue(R) portable hemoglobin photometer in a resource poor setting","volume":"11","author":"B Nkrumah","year":"2011","journal-title":"BMC Clin Pathol"},{"issue":"3","key":"pmed.1003739.ref048","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1177\/2211068212457560","article-title":"Hemoglobin point-of-care testing: the HemoCue system","volume":"18","author":"F Sanchis-Gomar","year":"2013","journal-title":"J Lab Autom"},{"issue":"1","key":"pmed.1003739.ref049","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1136\/jcp.2004.018366","article-title":"Evaluation and costs of different haemoglobin methods for use in district hospitals in Malawi","volume":"58","author":"A Medina Lara","year":"2005","journal-title":"J Clin Pathol"},{"issue":"2","key":"pmed.1003739.ref050","first-page":"191","article-title":"Validity and correspondence of non-invasively determined hemoglobin concentrations by two trans-cutaneous digital measuring devices","volume":"21","author":"C Crowley","year":"2012","journal-title":"Asia Pac J Clin Nutr"},{"issue":"1","key":"pmed.1003739.ref051","doi-asserted-by":"crossref","first-page":"e30065","DOI":"10.1371\/journal.pone.0030065","article-title":"Non-invasive measurement of hemoglobin: assessment of two different point-of-care technologies","volume":"7","author":"E Gayat","year":"2012","journal-title":"PLoS ONE"},{"key":"pmed.1003739.ref052","unstructured":"PATH. Noninvasive technology for anemia detection. Seattle, WA, USA: PATH. [cited 2020 Aug 21]. Available from: http:\/\/www.path.org\/publications\/files\/TS_update_anemia.pdf."},{"key":"pmed.1003739.ref053","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s12916-015-0320-9","article-title":"The predictive value of current haemoglobin levels for incident tuberculosis and\/or mortality during long-term antiretroviral therapy in South Africa: a cohort study","volume":"13","author":"AD Kerkhoff","year":"2015","journal-title":"BMC Med"},{"key":"pmed.1003739.ref054","article-title":"Relationship Between Blood Concentrations of Hepcidin and Anemia Severity, Mycobacterial Burden, and Mortality Among Patients With HIV-Associated Tuberculosis","author":"AD Kerkhoff","year":"2015","journal-title":"J Infect Dis"},{"issue":"6108","key":"pmed.1003739.ref055","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1126\/science.1224577","article-title":"Hepcidin and the iron-infection axis","volume":"338","author":"H Drakesmith","year":"2012","journal-title":"Science"},{"issue":"13","key":"pmed.1003739.ref056","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1097\/QAD.0000000000001902","article-title":"C-reactive protein as a screening test for HIV-associated pulmonary tuberculosis prior to antiretroviral therapy in South Africa","volume":"32","author":"AE Shapiro","year":"2018","journal-title":"AIDS"},{"issue":"12","key":"pmed.1003739.ref057","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1016\/S1473-3099(17)30488-7","article-title":"Point-of-care C-reactive protein-based tuberculosis screening for people living with HIV: a diagnostic accuracy study","volume":"17","author":"C Yoon","year":"2017","journal-title":"Lancet Infect Dis"},{"issue":"2","key":"pmed.1003739.ref058","doi-asserted-by":"crossref","first-page":"283","DOI":"10.5588\/ijtld.12.0803","article-title":"Serum C-reactive protein measurement for ruling out HIV-associated tuberculosis","volume":"17","author":"SD Lawn","year":"2013","journal-title":"Int J Tuberc Lung Dis"},{"key":"pmed.1003739.ref059","unstructured":"WHO. WHO operational handbook on tuberculosis. Module 2: systematic screening for tuberculosis disease. [cited 2021 Apr 12]. Available from: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/340256\/9789240022614-eng.pdf."},{"issue":"2","key":"pmed.1003739.ref060","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.cmi.2018.07.017","article-title":"Acute phase proteins and IP-10 as triage tests for the diagnosis of tuberculosis: systematic review and meta-analysis","volume":"25","author":"VS Santos","year":"2019","journal-title":"Clin Microbiol Infect"},{"issue":"1","key":"pmed.1003739.ref061","doi-asserted-by":"crossref","first-page":"e1002489","DOI":"10.1371\/journal.pmed.1002489","article-title":"Estimated mortality on HIV treatment among active patients and patients lost to follow-up in 4 provinces of Zambia: Findings from a multistage sampling-based survey","volume":"15","author":"CB Holmes","year":"2018","journal-title":"PLoS Med"},{"issue":"5","key":"pmed.1003739.ref062","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1097\/QAD.0000000000002140","article-title":"the Antiretroviral Therapy Cohort C. Albumin, white blood cell count, and body mass index improve discrimination of mortality in HIV-positive individuals","volume":"33","author":"JP Tate","year":"2019","journal-title":"AIDS"},{"issue":"4","key":"pmed.1003739.ref063","first-page":"59","article-title":"Why sub-Saharan Africa lags in electronic health record adoption and possible strategies to increase its adoption in this region","volume":"11","author":"FF Odekunle","year":"2017","journal-title":"Int J Health Sci (Qassim)"},{"issue":"1","key":"pmed.1003739.ref064","first-page":"1","article-title":"Use of Electronic Health Records in sub-Saharan Africa: Progress and challenges","volume":"14","author":"MO Akanbi","year":"2012","journal-title":"J Med Trop"},{"issue":"11","key":"pmed.1003739.ref065","doi-asserted-by":"crossref","first-page":"e0166158","DOI":"10.1371\/journal.pone.0166158","article-title":"Autopsy Prevalence of Tuberculosis and Other Potentially Treatable Infections among Adults with Advanced HIV Enrolled in Out-Patient Care in South Africa","volume":"11","author":"AS Karat","year":"2016","journal-title":"PLoS ONE"},{"issue":"6","key":"pmed.1003739.ref066","doi-asserted-by":"crossref","first-page":"670","DOI":"10.5588\/ijtld.16.0843","article-title":"Isoniazid-monoresistant tuberculosis is associated with poor treatment outcomes in Durban, South Africa","volume":"21","author":"YF van der Heijden","year":"2017","journal-title":"Int J Tuberc Lung Dis"},{"issue":"8","key":"pmed.1003739.ref067","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1164\/rccm.201004-0620OC","article-title":"Costs and consequences of additional chest x-ray in a tuberculosis prevention program in Botswana","volume":"183","author":"T Samandari","year":"2011","journal-title":"Am J Respir Crit Care Med"},{"issue":"4","key":"pmed.1003739.ref068","doi-asserted-by":"crossref","first-page":"e1002278","DOI":"10.1371\/journal.pmed.1002278","article-title":"Clinical decision tools are needed to identify HIV-positive patients at high risk for poor outcomes after initiation of antiretroviral therapy","volume":"14","author":"ML McNairy","year":"2017","journal-title":"PLoS Med"},{"key":"pmed.1003739.ref069","unstructured":"Shapiro AE, Chakravorty R, Akande T, Lonnroth K, Golub JE. A systematic review of the number needed to screen to detect a case of active tuberculosis in different risk groups. [cited 2020 Jun 10]. Available from: https:\/\/www.who.int\/tb\/Review3NNS_case_active_TB_riskgroups.pdf?ua=1."},{"issue":"3","key":"pmed.1003739.ref070","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.amepre.2015.08.031","article-title":"Precision Public Health for the Era of Precision Medicine","volume":"50","author":"MJ Khoury","year":"2016","journal-title":"Am J Prev Med"},{"issue":"1","key":"pmed.1003739.ref071","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2471\/BLT.16.187021","article-title":"Addressing tuberculosis in differentiated care provision for people living with HIV","volume":"95","author":"I Pathmanathan","year":"2017","journal-title":"Bull World Health Organ"},{"key":"pmed.1003739.ref072","article-title":"Collective Call to Action for HIV\/AIDS Community-Based Collaborative Science in the Era of COVID-19","author":"S Shoptaw","year":"2020","journal-title":"AIDS Behav"},{"issue":"8","key":"pmed.1003739.ref073","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1093\/trstmh\/trw056","article-title":"Xpert MTB\/RIF\u2014why the lack of morbidity and mortality impact in intervention trials?","volume":"110","author":"AF Auld","year":"2016","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"Suppl 3","key":"pmed.1003739.ref074","doi-asserted-by":"crossref","first-page":"S270","DOI":"10.1097\/QAI.0000000000000485","article-title":"TB screening among people living with HIV\/AIDS in resource-limited settings","volume":"68","author":"A Date","year":"2015","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"6","key":"pmed.1003739.ref075","doi-asserted-by":"crossref","first-page":"e798","DOI":"10.1016\/S2214-109X(19)30164-0","article-title":"Point of care Xpert MTB\/RIF versus smear microscopy for tuberculosis diagnosis in southern African primary care clinics: a multicentre economic evaluation","volume":"7","author":"A Pooran","year":"2019","journal-title":"Lancet Glob Health"},{"issue":"9","key":"pmed.1003739.ref076","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1093\/cid\/cix988","article-title":"Optimizing Tuberculosis Diagnosis in Human Immunodeficiency Virus-Infected Inpatients Meeting the Criteria of Seriously Ill in the World Health Organization Algorithm","volume":"66","author":"R Griesel","year":"2018","journal-title":"Clin Infect Dis"},{"key":"pmed.1003739.ref077","unstructured":"Firmin S. Seeing the Forest for the Trees: An Introduction to Random Forest. [cited 2020 Jun 3]. Available from: https:\/\/towardsdatascience.com\/seeing-the-forest-for-the-trees-an-introduction-to-random-forest-41a24fc842ac."},{"issue":"26","key":"pmed.1003739.ref078","doi-asserted-by":"crossref","first-page":"2507","DOI":"10.1056\/NEJMp1702071","article-title":"Machine Learning and Prediction in Medicine\u2014Beyond the Peak of Inflated Expectations","volume":"376","author":"JH Chen","year":"2017","journal-title":"N Engl J Med"},{"issue":"14","key":"pmed.1003739.ref079","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1056\/NEJMra1814259","article-title":"Machine Learning in Medicine","volume":"380","author":"A Rajkomar","year":"2019","journal-title":"N Engl J Med"}],"updated-by":[{"DOI":"10.1371\/journal.pmed.1003739","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,9,21]],"date-time":"2021-09-21T00:00:00Z","timestamp":1632182400000}}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003739","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,21]],"date-time":"2021-09-21T18:41:44Z","timestamp":1632249704000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003739"}},"subtitle":[],"editor":[{"given":"Sydney","family":"Rosen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,9,7]]},"references-count":79,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9,7]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmed.1003739","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pmed.1003739","asserted-by":"object"}]},"ISSN":["1549-1676"],"issn-type":[{"value":"1549-1676","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,7]]}}}