{
  "abstract": "Systematic screening for tuberculosis (TB) is recommended in people with diabetes; however, data on the accuracy of screening tools in this population are lacking. We assessed the accuracy of symptom and chest X-ray screening among people with diabetes. We consecutively enrolled adults with diabetes attending routine care in South Africa. All participants underwent symptom screening and chest X-ray. A single sputum specimen was collected from all participants and tested by Xpert Ultra. A positive Xpert Ultra result was used as the reference standard. We enrolled 673 participants. The median age was 54 years (interquartile range 47–60 years), and 63.8% were female. HIV prevalence was 17.2%. Prevalent TB was diagnosed in nine participants (1.33%). Any cough had a sensitivity of 22.2% (95% confidence interval [CI] 2.1-60.0%) and a specificity of 97.5% (95%CI 96.0-98.6%). Expanding the symptom definition to include any of cough, fever, weight loss, or night sweats did not improve sensitivity (22.2%, 95% CI 2.1–60.0) and slightly reduced specificity to 96.0% (95% CI 94.2–97.0). Chest X-ray abnormalities suggestive of TB demonstrated a sensitivity of 55.6% (95%CI 21.2-86.3%) and a specificity of 95.4% (95%CI 93.4-97.0%). The specificity of chest X-ray was significantly lower in participants with prior TB (87.6%, 95% CI: 79.8–90.6%), compared to 97.2% (95% CI: 95.2–98.5%) in those without (p < 0.01). Symptom-based TB screening has poor sensitivity in people with diabetes. Although chest X-ray improved the sensitivity, it remained suboptimal, with a reduced specificity in people with previous TB.",
  "abstract_shown": true,
  "affiliations": [
    "Institute for Global Health, University College London, London, United Kingdom",
    "Wellcome Discovery Research Platforms for Infection, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa",
    "MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, United Kingdom",
    "The Francis Crick Institute, London, United Kingdom",
    "Department of Infectious Diseases, Imperial College London, London, United Kingdom",
    "School of Public Health and Clinical Infectious Disease Research Institute-AFRICA, University of Cape Town, Cape Town, South Africa"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
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        0
      ],
      "name": "Neha Janrode"
    },
    {
      "affs": [
        1
      ],
      "name": "Yohhei Hamada"
    },
    {
      "affs": [
        2
      ],
      "name": "Arshad Taliep"
    },
    {
      "affs": [
        3
      ],
      "name": "Lauren Barron"
    },
    {
      "affs": [
        4
      ],
      "name": "Walter Chabaya"
    },
    {
      "affs": [
        5
      ],
      "name": "Rene T. Goliath"
    },
    {
      "name": "Trinh Duong"
    },
    {
      "name": "Amanda Jackson"
    },
    {
      "name": "Shireen Galant"
    },
    {
      "name": "Nashreen Omar-Davies"
    },
    {
      "name": "Louise Lai Sai"
    },
    {
      "name": "Lillian Twentiey"
    },
    {
      "name": "Robert J. Wilkinson"
    },
    {
      "name": "Molebogeng X. Rangaka"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1q1j0t7k22y8z.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pgph.0006479",
  "fulltext_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006479",
  "id": "1q1j0t7k22y8z",
  "issns": [
    "2767-3375"
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  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2725|Tuberculosis Research and Epidemiology"
    ],
    [
      "plos",
      "/Biology and life sciences/Anatomy/Body fluids/Mucus/Sputum"
    ],
    [
      "plos",
      "/Biology and life sciences/Physiology/Body fluids/Mucus/Sputum"
    ],
    [
      "plos",
      "/Biology and life sciences/Physiology/Physiological processes/Coughing"
    ],
    [
      "plos",
      "/Medicine and health sciences/Anatomy/Body fluids/Mucus/Sputum"
    ],
    [
      "plos",
      "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Coughing"
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      "/Medicine and health sciences/Clinical medicine/Signs and symptoms/HIV clinical manifestations"
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      "plos",
      "/Medicine and health sciences/Diagnostic medicine/Diagnostic radiology/X-ray radiography"
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      "plos",
      "/Medicine and health sciences/Diagnostic medicine/HIV diagnosis and management"
    ],
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      "plos",
      "/Medicine and health sciences/Diagnostic medicine/Tuberculosis diagnosis and management"
    ],
    [
      "plos",
      "/Medicine and health sciences/Endocrinology/Endocrine disorders/Diabetes mellitus"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Infectious diseases/Bacterial diseases/Tuberculosis"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Metabolic disorders/Diabetes mellitus"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Tropical diseases/Tuberculosis"
    ],
    [
      "plos",
      "/Medicine and health sciences/Radiology and imaging/Diagnostic radiology/Bone imaging/X-ray radiography"
    ],
    [
      "plos",
      "/Medicine and health sciences/Radiology and imaging/Diagnostic radiology/X-ray radiography"
    ],
    [
      "plos",
      "/Research and analysis methods/Imaging techniques/Diagnostic radiology/Bone imaging/X-ray radiography"
    ],
    [
      "plos",
      "/Research and analysis methods/Imaging techniques/Diagnostic radiology/X-ray radiography"
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  "openalex": "W7214987815",
  "pdf_url": "https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0006479&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-30",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/1q1j0t7k22y8z.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:37Z",
      "native_id": "10.1371/journal.pgph.0006479",
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      "url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006479"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "plos:diagnostic radiology",
      "subfield": "imaging"
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    {
      "field": "medicine",
      "origin": "plos:anatomy",
      "subfield": "physiology"
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  "title": "Sensitivity and specificity of tuberculosis screening tools in people with diabetes",
  "title_text": "Sensitivity and specificity of tuberculosis screening tools in people with diabetes",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:37Z",
  "url": "https://research.draconitic.com/paper/1q1j0t7k22y8z",
  "venue": "PLOS Global Public Health",
  "versions": []
}