{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:15:54Z","timestamp":1782360954663,"version":"3.54.5"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003042","name":"Else Kr\u00f6ner-Fresenius-Stiftung","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100003042","id-type":"DOI","asserted-by":"crossref"}]},{"name":"the Light Foundation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"the Polish embassy in Tanzania","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"and the Directorate General for Development Cooperation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec018\">\n<jats:title>Background<\/jats:title>\n<jats:p>Prior studies that used Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO)-trained African giant pouched rats reported an annual average of 40% increase in sputum-smear-positive tuberculosis (TB) detection. Sputum-smear microscopy (smear) is being replaced by Xpert MTB\/RIF (Xpert)-based diagnostic algorithms in many countries. We evaluated the incremental values of rat-based case detection over smear and Xpert.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec019\">\n<jats:title>Methods<\/jats:title>\n<jats:p>From January to December 2023, sputum samples were collected from presumptive TB patients at 69 health facilities that use Xpert or smear-based diagnostic algorithms. An average of five rats were used at APOPO to re-evaluate the second sample from Xpert-negative patients and the smear-negative sample. Concentrated smears and Ziehl-Neelsen staining were used to confirm samples that were rat-positive (samples indicated positive by \u2009\u2265\u20091 rat). We analyzed the increase in case detection (incremental yield) by the rats over smear and Xpert and compared the rise against <jats:italic>Mycobacterium<\/jats:italic> bacillary load using the Chi-square test.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec020\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 43,153 samples from 34,565 patients were collected and re-evaluated by rats. There were 6,717 bacteriologically confirmed TB cases; 4,541 (68%) of these cases were detected at health facilities (3,239 from Xpert and 1,302 from smear sites); the remaining 2,176 (32%) were found by trained rats, representing 48% (2,176\/4,541) overall incremental value. Of which, 65% (1,409\/2,176) and 35% (767\/2,176) were among Xpert and smear-negative patients, respectively. The Incremental yield by rats at Xpert facilities was 44% (1,409\/3,239), while it was 59% (767\/1,302) at smear facilities, Odds Ratio, OR\u2009=\u20090.74, 95% confidence interval, CI:0.66\u20130.82. The rats were 47% more likely to identify TB among Acid Fast Bacilli smear 1\u2009+ \u2009or scanty from Xpert-negative samples than smear-negative [91% (1,276\/1,409) versus 87% (665\/767), OR\u2009=\u20091.47, 95% CI:1.12\u20131.94]. The difference between children and adults, however, was not substantial, [69% (68\/98) versus 67% (1,138\/1,701), OR\u2009=\u20091.12, 95% CI:0.72\u20131.74].<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec021\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our finding indicated that trained rats reasonably added benefit over DOT TB case findings. According to our data, switching from smear to Xpert sites lowered the added value by more than a quarter, even though the Xpert sites were likely to benefit more case finding among TB patients with lower bacillary loads.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0321866","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T17:29:52Z","timestamp":1745947792000},"page":"e0321866","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["The incremental value of tuberculosis detecting African giant pouched rats over Smear microscopy and Xpert MTB\/RIF for Tanzanian TB detection"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1848-7307","authenticated-orcid":true,"given":"Tefera 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Tuberculosis: integrated studies for a complex disease","author":"N Beyene","year":"2023"},{"key":"pone.0321866.ref013","author":"StataCorp","year":"2015"},{"key":"pone.0321866.ref014","doi-asserted-by":"crossref","first-page":"2429","DOI":"10.2147\/IDR.S307488","article-title":"Dependence of Xpert MTB\/RIF accuracy for detecting rifampin resistance in bronchoalveolar lavage fluid on bacterial load: a retrospective study in Beijing, China","volume":"14","author":"L Qin","year":"2021","journal-title":"Infect Drug Resist"},{"issue":"9","key":"pone.0321866.ref015","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.5588\/ijtld.17.0792","article-title":"Discordance in Xpert\u00ae MTB\/RIF assay results among low bacterial load clinical specimens in Bangladesh","volume":"22","author":"M Sahrin","year":"2018","journal-title":"Int J Tuberc Lung Dis"},{"key":"pone.0321866.ref016","doi-asserted-by":"crossref","first-page":"e74","DOI":"10.1016\/S2666-5247(20)30007-0","article-title":"Prevalence and drivers of false-positive rifampicin-resistant Xpert MTB\/RIF results: a prospective observational study in Rwanda","volume":"1","author":"JCS Ngabonziza","year":"2020","journal-title":"Lancet Microbe"},{"key":"pone.0321866.ref017","author":"Global laboratory initiative, advancing TB diagnosis","year":"2017"},{"key":"pone.0321866.ref018","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"},{"issue":"2","key":"pone.0321866.ref019","doi-asserted-by":"crossref","first-page":"274e80","DOI":"10.1128\/JCM.01199-11","article-title":"Diagnosis of tuberculosis by trained African giant pouched rats and confounding impact of pathogens and microflora of the respiratory tract","volume":"50","author":"GF Mgode","year":"2012","journal-title":"J Clin Microbiol"},{"issue":"2","key":"pone.0321866.ref020","doi-asserted-by":"crossref","first-page":"420","DOI":"10.4102\/ajlm.v6i2.420","article-title":"Tuberculosis diagnostic technology: an African solution \u2026 think rats","volume":"6","author":"C Mulder","year":"2017","journal-title":"Afr J Lab Med"},{"key":"pone.0321866.ref021","unstructured":"Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO), strategic plan, Morogoro, Tanzania, 2023-2025."}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0321866","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T17:30:04Z","timestamp":1745947804000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0321866"}},"subtitle":[],"editor":[{"given":"Fredrick Baragi","family":"Haraka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,29]]},"references-count":21,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0321866","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,29]]}}}