Mind the Clinic-Community Gap: Re-evaluation of Test Performance and False Positive Results in Community-Wide Tuberculosis Screening

Community-wide screening for bacteriologically confirmed pulmonary tuberculosis may reduce the tuberculosis burden, although concerns of overtreatment remain because of false positive diagnoses due to subpar specificity of current bacteriological tests for screening. Our review and data analysis show that clinic-based test specificity estimates of Xpert against culture underestimate performance in communities, for both Xpert MTB/RIF(99.8% for community vs 98.4% for clinic) and Xpert Ultra (99.4% vs 95.6%, respectively), reducing the presumed false positivity of sputum Xpert, using culture as the reference, by 86.8% and 85.4%, respectively, compared with clinic-based specificity estimates. These findings support large-scale evaluation of community-wide screening for tuberculosis.

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Publication Details

Journal
The Journal of Infectious Diseases
Published
2025-05-23
DOI
https://doi.org/10.1093/infdis/jiaf268
Citations
7
Primary Topic
Tuberculosis Research and Epidemiology
Type
article
Field-Weighted Citation Impact
9.77

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article

Mind the Clinic-Community Gap: Re-evaluation of Test Performance and False Positive Results in Community-Wide Tuberculosis Screening

Alvaro Schwalb, Katherine Chisholm Horton, Reinout van Crevel, Bachti Alisjahbana et al.
7 citations
The Journal of Infectious Diseases
Tuberculosis Research and Epidemiology
9.77
article

Mind the Clinic-Community Gap: Re-evaluation of Test Performance and False Positive Results in Community-Wide Tuberculosis Screening

Alvaro Schwalb, Katherine Chisholm Horton, Reinout van Crevel, Bachti Alisjahbana, Rein M G J Houben, Raspati Cundarani Koesoemadinata, Lara D Veeken
article en
7 citations

Abstract

Community-wide screening for bacteriologically confirmed pulmonary tuberculosis may reduce the tuberculosis burden, although concerns of overtreatment remain because of false positive diagnoses due to subpar specificity of current bacteriological tests for screening. Our review and data analysis show that clinic-based test specificity estimates of Xpert against culture underestimate performance in communities, for both Xpert MTB/RIF(99.8% for community vs 98.4% for clinic) and Xpert Ultra (99.4% vs 95.6%, respectively), reducing the presumed false positivity of sputum Xpert, using culture as the reference, by 86.8% and 85.4%, respectively, compared with clinic-based specificity estimates. These findings support large-scale evaluation of community-wide screening for tuberculosis.

The Journal of Infectious DiseasesVol. 232(2)
University of London (GB), Radboud University Nijmegen (NL), Universidad Peruana Cayetano Heredia (PE), Angkor Hospital for Children (KH), University Medical Center (US), Radboud University Medical Center (NL), University of Oxford (GB), Dr. Hasan Sadikin General Hospital (ID), London School of Hygiene & Tropical Medicine (GB), Instituto de Medicina Tropical (PY), Padjadjaran University (ID)
Bill and Melinda Gates Foundation, Government of the United Kingdom, Foreign, Commonwealth and Development Office, National Institutes of Health
Good health and well-being
Openalex Percentile: Top 2%
Tuberculosis Research and Epidemiology
9.77
DOIOpen Access PDFOpenAlex
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