{
  "abstract": "Mobile chest X-ray (CXR) screening interventions are recommended for tuberculosis (TB) screening in high-burden settings, but implementation costs are variable and underreported. Using time-driven activity-based costing, we evaluated the costs of implementing general-population mobile CXR screening in peri-urban Uganda. We conducted a micro-costing analysis of mobile CXR screening using data from an ongoing randomized crossover trial. We adopted a healthcare payer perspective, categorizing costs into equipment, personnel, space, implementation, and consumables. We calculated per-participant costs for each step in the TB screening cascade, as well as total screening and diagnostic costs per positive microbiological result (Xpert Ultra). Sensitivity analyses evaluated the cost implications of varying the screening volume or radiographic risk score thresholds. Among 90,668 age-eligible participants completing CXR screening, 14,630 sputum specimens were collected for Xpert testing (16.1%), including 1,676 from participants who submitted sputum without completing CXR. Overall, 511 participants had valid Xpert-positive results (3.5%), corresponding to 5.6 Xpert-positive results per 1,000 CXRs performed. The estimated cost was $4.41 per person screened and $1,299 per Xpert-positive result (95% uncertainty interval: $1,134-$1,488). Screening and diagnostic costs accounted for 64% and 36% of the cost per Xpert-positive result, respectively. Daily screening volume strongly influenced the cost per positive Xpert result, whereas less stringent X-ray thresholds increased the number of TB cases detected with minimal impact on average cost per positive Xpert. Mobile CXR screening interventions for TB require substantial investment in resources. Program planners can optimize efficiency by targeting high-burden populations, increasing participant volume, and optimizing X-ray risk cutoffs for follow-up diagnostic testing. Our findings highlight the value of context-specific cost data for guiding decisions on scaling up TB screening interventions.",
  "abstract_shown": true,
  "affiliations": [
    "Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America",
    "Uganda TB Implementation Research Consortium, Walimu, Kampala, Uganda",
    "Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America",
    "Clinical Epidemiology and Biostatics Unit, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda",
    "Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
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        0
      ],
      "name": "Tyler Scott Johnson"
    },
    {
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        1
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      "name": "David Isooba"
    },
    {
      "affs": [
        2
      ],
      "name": "Susan Birabwa"
    },
    {
      "affs": [
        3
      ],
      "name": "Juliet Kakeeto"
    },
    {
      "affs": [
        4
      ],
      "name": "Kenneth Ndyabayunga"
    },
    {
      "name": "Deborah Nantale"
    },
    {
      "name": "Ivan Mugabi"
    },
    {
      "name": "Violet Nakiiza"
    },
    {
      "name": "Annet Nalutaaya"
    },
    {
      "name": "Peter James Kitonsa"
    },
    {
      "name": "Emily A. Kendall"
    },
    {
      "name": "Achilles Katamba"
    },
    {
      "name": "David W. Dowdy"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1t552yenb0p28.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pgph.0005950",
  "fulltext_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005950",
  "id": "1t552yenb0p28",
  "issns": [
    "2767-3375"
  ],
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  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
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  "native_subjects": [
    [
      "openalex",
      "2725|Tuberculosis Research and Epidemiology"
    ],
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      "/Biology and life sciences/Anatomy/Body fluids/Mucus/Sputum"
    ],
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      "plos",
      "/Biology and life sciences/Physiology/Body fluids/Mucus/Sputum"
    ],
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      "/Computer and information sciences/Software engineering/Computer software"
    ],
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      "plos",
      "/Engineering and technology/Equipment"
    ],
    [
      "plos",
      "/Engineering and technology/Software engineering/Computer software"
    ],
    [
      "plos",
      "/Medicine and health sciences/Anatomy/Body fluids/Mucus/Sputum"
    ],
    [
      "plos",
      "/Medicine and health sciences/Diagnostic medicine/Tuberculosis diagnosis and management"
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      "/Medicine and health sciences/Epidemiology/Medical risk factors"
    ],
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      "plos",
      "/Medicine and health sciences/Medical conditions/Infectious diseases/Bacterial diseases/Tuberculosis"
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    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Tropical diseases/Tuberculosis"
    ],
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      "/Medicine and health sciences/Public and occupational health/Health screening"
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  "pdf_url": "https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0005950&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-10",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/1t552yenb0p28.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:56Z",
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  "subjects": [
    {
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      "origin": "plos:epidemiology",
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      "field": "medicine",
      "origin": "plos:anatomy",
      "subfield": "physiology"
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  "title": "Resources to implement general population mobile chest x-ray screening for tuberculosis in Uganda: A trial-based costing analysis",
  "title_text": "Resources to implement general population mobile chest x-ray screening for tuberculosis in Uganda: A trial-based costing analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:56Z",
  "url": "https://research.draconitic.com/paper/1t552yenb0p28",
  "venue": "PLOS Global Public Health",
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}