{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:08:17Z","timestamp":1790856497635,"version":"4.1.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T00:00:00Z","timestamp":1736726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U01AI152084"],"award-info":[{"award-number":["U01AI152084"]}],"id":[{"id":"10.13039\/100000060","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>Globally, over one-third of pulmonary tuberculosis (TB) disease diagnoses are made based on clinical criteria after a negative bacteriological test result. There is limited information on the factors that determine clinicians\u2019 decisions to initiate TB treatment when initial bacteriological test results are negative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>We performed a systematic review and individual patient data meta-analysis using studies conducted between January 2010 and December 2022 (PROSPERO: CRD42022287613). We included trials or cohort studies that enrolled individuals evaluated for TB in routine settings. In these studies, participants were evaluated based on clinical examination and routinely used diagnostics and were followed for \u22651 week after the initial test result. We used hierarchical Bayesian logistic regression to identify factors associated with treatment initiation following a negative result on an initial bacteriological test (e.g., sputum smear microscopy (SSM), Xpert MTB\/RIF).<\/jats:p>\n                    <jats:p>Multiple factors were positively associated with treatment initiation: male sex [adjusted odds ratio (aOR) 1.61 (1.31, 1.95)], history of prior TB [aOR 1.36 (1.06, 1.73)], reported cough [aOR 4.62 (3.42, 6.27)], reported night sweats [aOR 1.50 (1.21, 1.90)], and having HIV infection but not on ART [aOR 1.68 (1.23, 2.32)]. Treatment initiation was substantially less likely for individuals testing negative with Xpert [aOR 0.77 (0.62, 0.96)] compared to smear microscopy and declined in more recent years. We were not able assess why clinicians made treatment decisions, as these data were not available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Multiple factors influenced decisions to initiate TB treatment despite negative test results. Clinicians were substantially less likely to treat in the absence of a positive test result when using more sensitive, PCR-based diagnostics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1004502","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T14:03:18Z","timestamp":1736776998000},"page":"e1004502","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Factors associated with tuberculosis treatment initiation among bacteriologically negative individuals evaluated for tuberculosis: An individual patient data meta-analysis"],"prefix":"10.1371","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2466-2442","authenticated-orcid":true,"given":"Sun","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6810-0356","authenticated-orcid":true,"given":"Melike Hazal","family":"Can","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1848-7307","authenticated-orcid":true,"given":"Tefera B.","family":"Agizew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5089-9163","authenticated-orcid":true,"given":"Andrew F.","family":"Auld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7223-9665","authenticated-orcid":true,"given":"Maria Elvira","family":"Balcells","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9046-6255","authenticated-orcid":true,"given":"Stephanie","family":"Bjerrum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keertan","family":"Dheda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan E.","family":"Dorman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1835-9252","authenticated-orcid":true,"given":"Aliasgar","family":"Esmail","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"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2038-5505","authenticated-orcid":true,"given":"Alberto L.","family":"Garcia-Basteiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4544-4591","authenticated-orcid":true,"given":"Colleen F.","family":"Hanrahan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4309-8143","authenticated-orcid":true,"given":"Wakjira","family":"Kebede","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikashmi","family":"Kohli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0911-1578","authenticated-orcid":true,"given":"Anne F.","family":"Luetkemeyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3059-1369","authenticated-orcid":true,"given":"Carol","family":"Mita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byron W. P.","family":"Reeve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise Rossato","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4233-9080","authenticated-orcid":true,"given":"Sedona","family":"Sweeney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9216-2415","authenticated-orcid":true,"given":"Grant","family":"Theron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4000-4984","authenticated-orcid":true,"given":"Anete","family":"Trajman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Vassall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6274-6970","authenticated-orcid":true,"given":"Joshua L.","family":"Warren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2110-2631","authenticated-orcid":true,"given":"Marcel","family":"Yotebieng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8091-7198","authenticated-orcid":true,"given":"Ted","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2571-016X","authenticated-orcid":true,"given":"Nicolas A.","family":"Menzies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,13]]},"reference":[{"key":"pmed.1004502.ref001","unstructured":"World Health Organization. Global Tuberculosis Report 2023 [Internet]. 2023 [cited 2024 Jan 15]. https:\/\/www.who.int\/teams\/global-tuberculosis-programme\/tb-reports\/global-tuberculosis-report-2023."},{"key":"pmed.1004502.ref002","unstructured":"World Health Organization. The end TB strategy [Internet]. 2015. https:\/\/www.who.int\/publications-detail-redirect\/WHO-HTM-TB-2015.19."},{"key":"pmed.1004502.ref003","unstructured":"World Health Organization. WHO consolidated guidelines on tuberculosis. Module 3: Diagnosis\u2014Rapid diagnostics for tuberculosis detection 2021 update [Internet]. 2021. https:\/\/www.who.int\/publications-detail-redirect\/9789240029415."},{"issue":"639","key":"pmed.1004502.ref004","doi-asserted-by":"crossref","first-page":"eabj4124","DOI":"10.1126\/scitranslmed.abj4124","article-title":"Point-of-care diagnostic tests for tuberculosis disease","volume":"14","author":"JM Hong","year":"2022","journal-title":"Sci Transl Med"},{"issue":"8","key":"pmed.1004502.ref005","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/S2213-2600(15)00198-8","article-title":"Burden of tuberculosis in intensive care units in Cape Town, South Africa, and assessment of the accuracy and effect on patient outcomes of the Xpert MTB\/RIF test on tracheal aspirate samples for diagnosis of pulmonary tuberculosis: a prospective burden of disease study with a nested randomised controlled trial","volume":"3","author":"GL Calligaro","year":"2015","journal-title":"Lancet Respir Med"},{"issue":"8","key":"pmed.1004502.ref006","doi-asserted-by":"crossref","first-page":"e450","DOI":"10.1016\/S2214-109X(15)00100-X","article-title":"Xpert MTB\/RIF versus sputum microscopy as the initial diagnostic test for tuberculosis: a cluster-randomised trial embedded in South African roll-out of Xpert MTB\/RIF","volume":"3","author":"GJ Churchyard","year":"2015","journal-title":"Lancet Glob Health"},{"issue":"11","key":"pmed.1004502.ref007","doi-asserted-by":"crossref","first-page":"e1001760","DOI":"10.1371\/journal.pmed.1001760","article-title":"Impact of Xpert MTB\/RIF for TB diagnosis in a primary care clinic with high TB and HIV prevalence in South Africa: a pragmatic randomised trial","volume":"11","author":"HS Cox","year":"2014","journal-title":"PLoS Med"},{"issue":"12","key":"pmed.1004502.ref008","doi-asserted-by":"crossref","first-page":"e1001766","DOI":"10.1371\/journal.pmed.1001766","article-title":"Impact of Replacing Smear Microscopy with Xpert MTB\/RIF for Diagnosing Tuberculosis in Brazil: A Stepped-Wedge Cluster-Randomized Trial","volume":"11","author":"B Durovni","year":"2014","journal-title":"PLoS Med"},{"issue":"6","key":"pmed.1004502.ref009","doi-asserted-by":"crossref","first-page":"e65421","DOI":"10.1371\/journal.pone.0065421","article-title":"Time to treatment and patient outcomes among TB suspects screened by a single point-of-care xpert MTB\/RIF at a primary care clinic in Johannesburg, South Africa","volume":"8","author":"CF Hanrahan","year":"2013","journal-title":"PLoS ONE"},{"issue":"1","key":"pmed.1004502.ref010","doi-asserted-by":"crossref","first-page":"ofu038","DOI":"10.1093\/ofid\/ofu038","article-title":"Impact of Xpert MTB\/RIF on Antiretroviral Therapy-Associated Tuberculosis and Mortality: A Pragmatic Randomized Controlled Trial","volume":"1","author":"L Mupfumi","year":"2014","journal-title":"Open Forum Infect Dis"},{"issue":"9915","key":"pmed.1004502.ref011","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/S0140-6736(13)62073-5","article-title":"Feasibility, accuracy, and clinical effect of point-of-care Xpert MTB\/RIF testing for tuberculosis in primary-care settings in Africa: a multicentre, randomised, controlled trial","volume":"383","author":"G Theron","year":"2014","journal-title":"Lancet"},{"issue":"4","key":"pmed.1004502.ref012","doi-asserted-by":"crossref","first-page":"e0123252","DOI":"10.1371\/journal.pone.0123252","article-title":"Impact on Patients\u2019 Treatment Outcomes of XpertMTB\/RIF Implementation for the Diagnosis of Tuberculosis: Follow-Up of a Stepped-Wedge Randomized Clinical Trial","volume":"10","author":"A Trajman","year":"2015","journal-title":"PLoS ONE"},{"issue":"11","key":"pmed.1004502.ref013","doi-asserted-by":"crossref","first-page":"e48599","DOI":"10.1371\/journal.pone.0048599","article-title":"Impact of Xpert MTB\/RIF testing on tuberculosis management and outcomes in hospitalized patients in Uganda","volume":"7","author":"C Yoon","year":"2012","journal-title":"PLoS ONE"},{"issue":"8","key":"pmed.1004502.ref014","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":"1","key":"pmed.1004502.ref015","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S1473-3099(14)71049-7","article-title":"Effect of empirical treatment on outcomes of clinical trials of diagnostic assays for tuberculosis","volume":"15","author":"SD Lawn","year":"2015","journal-title":"Lancet Infect Dis"},{"issue":"8","key":"pmed.1004502.ref016","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/S2213-2600(15)00231-3","article-title":"Should countries implement Xpert MTB\/RIF when empirical treatment precludes a clinical effect?","volume":"3","author":"AV Rie","year":"2015","journal-title":"Lancet Respir Med"},{"issue":"6","key":"pmed.1004502.ref017","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/S1473-3099(13)70360-8","article-title":"Do high rates of empirical treatment undermine the potential effect of new diagnostic tests for tuberculosis in high-burden settings?","volume":"14","author":"G Theron","year":"2014","journal-title":"Lancet Infect Dis"},{"key":"pmed.1004502.ref018","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1186\/1756-0500-4-475","article-title":"Sputum smear negative pulmonary tuberculosis: sensitivity and specificity of diagnostic algorithm","volume":"4","author":"HF Swai","year":"2011","journal-title":"BMC Res Notes"},{"issue":"12","key":"pmed.1004502.ref019","doi-asserted-by":"crossref","first-page":"e51336","DOI":"10.1371\/journal.pone.0051336","article-title":"Performance of the 2007 WHO Algorithm to Diagnose Smear-Negative Pulmonary Tuberculosis in a HIV Prevalent Setting","volume":"7","author":"H Huerga","year":"2012","journal-title":"PLoS ONE"},{"issue":"1","key":"pmed.1004502.ref020","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1186\/1471-2334-13-427","article-title":"Evaluation of the 2007 WHO guideline to diagnose smear negative tuberculosis in an urban hospital in Ethiopia","volume":"13","author":"G Abebe","year":"2013","journal-title":"BMC Infect Dis"},{"key":"pmed.1004502.ref021","unstructured":"Kim S, Can M, Dorman S, Sweeney S, Cohen T, Menzies N. Factors associated with TB treatment initiation among bacteriologically-negative TB suspects: an individual patient data meta-analysis. PROSPERO 2022 CRD42022287613. 2022; https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42022287613."},{"key":"pmed.1004502.ref022","unstructured":"World Health Organization. Algorithm for laboratory diagnosis and treatment-monitoring of pulmonary tuberculosis and drug-resistant tuberculosis using state-of-the-art rapid molecular diagnostic technologies. 2017."},{"issue":"8","key":"pmed.1004502.ref023","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1016\/j.jclinepi.2012.12.017","article-title":"Individual participant data meta-analyses should not ignore clustering","volume":"66","author":"G Abo-Zaid","year":"2013","journal-title":"J Clin Epidemiol"},{"issue":"5","key":"pmed.1004502.ref024","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1002\/sim.7141","article-title":"Meta-analysis using individual participant data: one-stage and two-stage approaches, and why they may differ","volume":"36","author":"DL Burke","year":"2017","journal-title":"Stat Med"},{"key":"pmed.1004502.ref025","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v080.i01","article-title":"brms: An R Package for Bayesian Multilevel Models Using Stan","volume":"80","author":"PC B\u00fcrkner","year":"2017","journal-title":"J Stat Softw"},{"issue":"1","key":"pmed.1004502.ref026","doi-asserted-by":"crossref","first-page":"395","DOI":"10.32614\/RJ-2018-017","article-title":"Advanced Bayesian Multilevel Modeling with the R Package brms","volume":"10","author":"PC B\u00fcrkner","year":"2018","journal-title":"R J"},{"key":"pmed.1004502.ref027","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v100.i05","article-title":"Bayesian Item Response Modeling in R with brms and Stan","volume":"100","author":"PC B\u00fcrkner","year":"2021","journal-title":"J Stat Softw"},{"key":"pmed.1004502.ref028","unstructured":"World Health Organization. Improving the diagnosis and treatment of smear-negative pulmonary and extrapulmonary tuberculosis among adults and adolescents. Recommendations for HIV-prevalent and resource-constrained settings [Internet]. 2006. chrome-extension:\/\/efaidnbmnnnibpcajpcglclefindmkaj\/viewer.html?pdfurl=https%3A%2F%2Fwww.who.int%2Ftb%2Fpublications%2F2006%2Ftbhiv_recommendations.pdf&clen=393462&chunk=true"},{"issue":"9","key":"pmed.1004502.ref029","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1016\/S1473-3099(20)30143-2","article-title":"Utility of broad-spectrum antibiotics for diagnosing pulmonary tuberculosis in adults: a systematic review and meta-analysis","volume":"20","author":"TH Divala","year":"2020","journal-title":"Lancet Infect Dis"},{"issue":"9","key":"pmed.1004502.ref030","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1001\/archinte.163.9.1009","article-title":"The growing burden of tuberculosis: global trends and interactions with the HIV epidemic","volume":"163","author":"EL Corbett","year":"2003","journal-title":"Arch Intern Med"},{"issue":"6","key":"pmed.1004502.ref031","doi-asserted-by":"crossref","first-page":"e20755","DOI":"10.1371\/journal.pone.0020755","article-title":"Assessing Tuberculosis Case Fatality Ratio: A Meta-Analysis","volume":"6","author":"M Straetemans","year":"2011","journal-title":"PLoS ONE"},{"issue":"10","key":"pmed.1004502.ref032","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.5588\/ijtld.11.0056","article-title":"Risk factors for mortality in smear-negative tuberculosis suspects: a cohort study in Harare, Zimbabwe","volume":"15","author":"P MacPherson","year":"2011","journal-title":"Int J Tuberc Lung Dis"},{"issue":"1","key":"pmed.1004502.ref033","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/S1473-3099(17)30691-6","article-title":"Xpert MTB\/RIF Ultra for detection of Mycobacterium tuberculosis and rifampicin resistance: a prospective multicentre diagnostic accuracy study","volume":"18","author":"SE Dorman","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"pmed.1004502.ref034","first-page":"CD009593","article-title":"Xpert MTB\/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults","volume":"1","author":"KR Steingart","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"issue":"6","key":"pmed.1004502.ref035","first-page":"CD009593","article-title":"Xpert MTB\/RIF and Xpert MTB\/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults","volume":"2019","author":"DJ Horne","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"issue":"11","key":"pmed.1004502.ref036","doi-asserted-by":"crossref","first-page":"e1001347","DOI":"10.1371\/journal.pmed.1001347","article-title":"Population Health Impact and Cost-Effectiveness of Tuberculosis Diagnosis with Xpert MTB\/RIF: A Dynamic Simulation and Economic Evaluation","volume":"9","author":"NA Menzies","year":"2012","journal-title":"PLoS Med"},{"issue":"1","key":"pmed.1004502.ref037","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/S1473-3099(14)71026-6","article-title":"Effect of empirical treatment on outcomes of clinical trials of diagnostic assays for tuberculosis","volume":"15","author":"NA Menzies","year":"2015","journal-title":"Lancet Infect Dis"},{"issue":"5","key":"pmed.1004502.ref038","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1183\/09031936.00111014","article-title":"The impact of novel tests for tuberculosis depends on the diagnostic cascade","volume":"44","author":"AY Sun","year":"2014","journal-title":"Eur Respir J"},{"issue":"7580","key":"pmed.1004502.ref039","doi-asserted-by":"crossref","first-page":"S60","DOI":"10.1038\/nature16045","article-title":"Understanding the incremental value of novel diagnostic tests for tuberculosis","volume":"528","author":"N Arinaminpathy","year":"2015","journal-title":"Nature"},{"issue":"2","key":"pmed.1004502.ref040","doi-asserted-by":"crossref","first-page":"e0228669","DOI":"10.1371\/journal.pone.0228669","article-title":"Situating trade-offs: Stakeholder perspectives on overtreatment versus missed diagnosis in transition to Xpert MTB\/RIF Ultra in Kenya and Swaziland","volume":"15","author":"M Mwaura","year":"2020","journal-title":"PLoS ONE"}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004502","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T14:03:35Z","timestamp":1736777015000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004502"}},"subtitle":[],"editor":[{"given":"Aaloke","family":"Mody","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,1,13]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,13]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmed.1004502","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2024.04.07.24305445","asserted-by":"object"}]},"ISSN":["1549-1676"],"issn-type":[{"value":"1549-1676","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,13]]}}}