Utility of the Urine GeneXpert MTB/RIF Assay for the Diagnosis of Mycobacterium Tuberculosis and Assessing Rifampicin Resistance in Sputum-scarce HIV Infected Individuals: A Scoping Review

Background and study aim: Tuberculosis (TB) remains the leading cause of death from a single infectious agent, disproportionately affecting people living with HIV (PLHIV). Advanced HIV disease often limits sputum production, leading to diagnostic delays and excess mortality. Urine-based molecular diagnostics such as the Urine GeneXpert (UGXP) offer a potential adjunctive or alternative testing strategy in sputum-scarce patients. This research mapped and synthesised the available evidence on the diagnostic performance of UGXP for Mycobacterium tuberculosis (MTB) detection and rifampicin resistance assessment among HIV-positive individuals unable to produce sputum.Methods: A scoping review was conducted following established methodological frameworks. Comprehensive searches of Google Scholar, Scopus, PubMed and Science Direct (2015–2025) identified 880 articles, of which 8 met inclusion criteria. Data on diagnostic accuracy, rifampicin resistance concordance, and clinical context were extracted and narratively synthesised.Results: Across studies (n=5235 participants, predominantly from high TB/HIV burden settings), UGXP sensitivity ranged from 17.2% to 70%, with specificity consistently between 95–100%. Diagnostic yield was higher in patients with advanced HIV or low CD4 counts. Compared with urine lipoarabinomannan (ULAM), UGXP demonstrated superior sensitivity and additional capacity to differentiate MTB from non-tuberculous mycobacteria. Rifampicin resistance results were largely concordant with sputum and culture-based testing, though false positives were noted in some studies.Conclusion: This review highlights the clinical utility of UGXP as an adjunct to conventional TB diagnostics in PLHIV, underscoring its potential to strengthen diagnostic capacity and improve patient outcomes in sub-Saharan Africa.