Sensitivity and specificity of tuberculosis screening tools in people with diabetes
6 affiliations
- 1Institute for Global Health, University College London, London, United Kingdom
- 2Wellcome Discovery Research Platforms for Infection, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
- 3MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, United Kingdom
- 4The Francis Crick Institute, London, United Kingdom
- 5Department of Infectious Diseases, Imperial College London, London, United Kingdom
- 6School of Public Health and Clinical Infectious Disease Research Institute-AFRICA, University of Cape Town, Cape Town, South Africa
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.
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BibTeX
@article{janrode2026sensitivity,
title = {{Sensitivity and specificity of tuberculosis screening tools in people with diabetes}},
author = {Neha Janrode and Yohhei Hamada and Arshad Taliep and Lauren Barron and Walter Chabaya and Rene T. Goliath and Trinh Duong and Amanda Jackson and Shireen Galant and Nashreen Omar-Davies and Louise Lai Sai and Lillian Twentiey and Robert J. Wilkinson and Molebogeng X. Rangaka},
journal = {PLOS Global Public Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pgph.0006479},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006479},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Sensitivity and specificity of tuberculosis screening tools in people with diabetes
AU - Neha Janrode
AU - Yohhei Hamada
AU - Arshad Taliep
AU - Lauren Barron
AU - Walter Chabaya
AU - Rene T. Goliath
AU - Trinh Duong
AU - Amanda Jackson
AU - Shireen Galant
AU - Nashreen Omar-Davies
AU - Louise Lai Sai
AU - Lillian Twentiey
AU - Robert J. Wilkinson
AU - Molebogeng X. Rangaka
PY - 2026
DA - 2026/09/30
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0006479
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006479
AB - 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.
SN - 2767-3375
ER -