Stock Ticker

Estimating the number of incorrect tuberculosis diagnoses in low- and middle-income countries

  • World Health Organization. The End TB Strategy (World Health Organization, 2015); https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/the-end-tb-strategy

  • Steingart, K. R. et al. Fluorescence versus conventional sputum smear microscopy for tuberculosis: a systematic review. Lancet Infect. Dis. 6, 570–581 (2006).

    Article 
    PubMed 

    Google Scholar
     

  • Cattamanchi, A. et al. Sensitivity of direct versus concentrated sputum smear microscopy in HIV-infected patients suspected of having pulmonary tuberculosis. BMC Infect. Dis. 9, 53 (2009).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • World Health Organization. Global TB Report 2024 (World Health Organization, 2024); https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024

  • Sossen, B. et al. The natural history of untreated pulmonary tuberculosis in adults: a systematic review and meta-analysis. Lancet Respir. Med. 11, 367–379 (2023).

    Article 
    PubMed 

    Google Scholar
     

  • WHO Global TB Programme. WHO Global TB Database 2023 (World Health Organization, accessed 30 March 2025); http://www.who.int/tb/country/data/download/en/

  • Houben, R. M. G. J. et al. What if they don’t have tuberculosis? The consequences and trade-offs involved in false-positive diagnoses of tuberculosis. Clin. Infect. Dis. 68, 150–156 (2018).

    Article 
    PubMed Central 

    Google Scholar
     

  • Walusimbi, S. et al. Meta-analysis to compare the accuracy of GeneXpert, MODS and the WHO 2007 algorithm for diagnosis of smear-negative pulmonary tuberculosis. BMC Infect. Dis. 13, 507 (2013).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • World Health Organization. National Surveys of Costs Faced by Tuberculosis Patients and Their Households 2015–2021 (World Health Organization, 2022); https://www.who.int/publications/i/item/9789240065536

  • Laurence, Y. V., Griffiths, U. K. & Vassall, A. Costs to health services and the patient of treating tuberculosis: a systematic literature review. PharmacoEconomics 33, 939–955 (2015).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Tostmann, A. et al. Antituberculosis drug-induced hepatotoxicity: concise up-to-date review. J. Gastroenterol. Hepatol. 23, 192–202 (2008).

    Article 
    PubMed 

    Google Scholar
     

  • Munro, S. A. et al. Patient adherence to tuberculosis treatment: a systematic review of qualitative research. PLoS Med. 4, e238 (2007).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Moreira, J. et al. Weighing harm in therapeutic decisions of smear-negative pulmonary tuberculosis. Med. Decis. Making 29, 380–390 (2009).

    Article 
    PubMed 

    Google Scholar
     

  • Horne, D. J. et al. Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst. Rev. 6, CD009593 (2019).

    PubMed 

    Google Scholar
     

  • Zifodya, J. S. et al. Xpert Ultra versus Xpert MTB/RIF for pulmonary tuberculosis and rifampicin resistance in adults with presumptive pulmonary tuberculosis. Cochrane Database Syst. Rev. 2, CD009593 (2021).

    PubMed 

    Google Scholar
     

  • Subbaraman, R. et al. The tuberculosis cascade of care in India’s public sector: a systematic review and meta-analysis. PLoS Med. 13, e1002149 (2016).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Naidoo, P. et al. The South African tuberculosis care cascade: estimated losses and methodological challenges. J. Infect. Dis. 216, S702–S713 (2017).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Emani, S. et al. Quantifying gaps in the tuberculosis care cascade in Brazil: a mathematical model study using national program data. PLoS Med. 21, e1004361 (2024).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Lalli, M. et al. Investigating the impact of TB case-detection strategies and the consequences of false positive diagnosis through mathematical modelling. BMC Infect. Dis. 18, 340 (2018).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Cilloni, L., Kranzer, K., Stagg, H. R. & Arinaminpathy, N. Trade-offs between cost and accuracy in active case finding for tuberculosis: a dynamic modelling analysis. PLoS Med. 17, e1003456 (2020).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Chadha, V. K. & Praseeja, P. Active tuberculosis case finding in India – the way forward. Indian J. Tuberc. 66, 170–177 (2019).

    Article 
    PubMed 

    Google Scholar
     

  • Dowdy, D. W., Steingart, K. R. & Pai, M. Serological testing versus other strategies for diagnosis of active tuberculosis in India: a cost-effectiveness analysis. PLoS Med. 8, e1001074 (2011).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Steingart, K. R. et al. Commercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis. PLoS Med. 8, e1001062 (2011).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Shewade, H. D., Satyanarayana, S. & Kumar, A. M. Does active case finding for tuberculosis generate more false-positives compared to passive case finding in India? Indian J. Tuberc. 68, 396–399 (2021).

    Article 
    PubMed 

    Google Scholar
     

  • Basinga, P., Moreira, J., Bisoffi, Z., Bisig, B. & Van den Ende, J. Why are clinicians reluctant to treat smear-negative tuberculosis? An inquiry about treatment thresholds in Rwanda. Med. Decis. Making 27, 53–60 (2007).

    Article 
    PubMed 

    Google Scholar
     

  • Vassall, A. et al. Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis. PLoS Med. 8, e1001120 (2011).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Menzies, N. A., Cohen, T., Lin, H. H., Murray, M. & Salomon, J. A. Population health impact and cost-effectiveness of tuberculosis diagnosis with Xpert MTB/RIF: a dynamic simulation and economic evaluation. PLoS Med. 9, e1001347 (2012).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Portnoy, A. et al. Costs incurred by people receiving tuberculosis treatment in low-income and middle-income countries: a meta-regression analysis. Lancet Glob. Health 11, e1640–e1647 (2023).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Burman, W. et al. Research on the treatment of rifampin-susceptible tuberculosis—time for a new approach. PLoS Med. 21, e1004438 (2024).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Jayasooriya, S. et al. Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis. Thorax 78, 50–60 (2023).

    Article 
    PubMed 

    Google Scholar
     

  • Thompson, R. R. et al. High mortality rates among individuals misdiagnosed with tuberculosis: a matched retrospective cohort study of individuals diagnosed with tuberculosis in Brazil. J. Infect. Dis. 231, 1267–1270 (2025).

    Article 
    PubMed 

    Google Scholar
     

  • Theron, G. et al. Do high rates of empirical treatment undermine the potential effect of new diagnostic tests for tuberculosis in high-burden settings? Lancet Infect. Dis. 14, 527–532 (2014).

    Article 
    PubMed 

    Google Scholar
     

  • Kim, S. et al. Factors associated with tuberculosis treatment initiation among bacteriologically negative individuals evaluated for tuberculosis: an individual patient data meta-analysis. PLoS Med. 22, e1004502 (2025).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Keeler, E. et al. Reducing the global burden of tuberculosis: the contribution of improved diagnostics. Nature 444, 49–57 (2006).

    Article 
    PubMed 

    Google Scholar
     

  • da Silva, M. P. et al. More than a decade of GeneXpert® Mycobacterium tuberculosis/Rifampicin (Ultra) testing in South Africa: laboratory insights from twenty-three million tests. Diagnostics 13, 3253 (2023).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • McDowell, A. & Pai, M. Treatment as diagnosis and diagnosis as treatment: empirical management of presumptive tuberculosis in India. Int. J. Tuberc. Lung Dis. 20, 536–543 (2016).

    Article 
    PubMed 

    Google Scholar
     

  • Mesfin, M. M., Tasew, T. W. & Richard, M. J. The quality of tuberculosis diagnosis in districts of Tigray region of northern Ethiopia. Ethiop. J. Health Dev. 19, 13 (2005).


    Google Scholar
     

  • Theron, G. et al. Feasibility, accuracy, and clinical effect of point-of-care Xpert MTB/RIF testing for tuberculosis in primary-care settings in Africa: a multicentre, randomised, controlled trial. Lancet 383, 424–435 (2014).

    Article 
    PubMed 

    Google Scholar
     

  • Hanson, C., Osberg, M., Brown, J., Durham, G. & Chin, D. P. Finding the missing patients with tuberculosis: lessons learned from patient-pathway analyses in 5 countries. J. Infect. Dis. 216(Suppl. 7), S686–S695 (2017).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • World Health Organization. WHO Consolidated Guidelines on Tuberculosis. Module 3: Diagnosis–Rapid Diagnostics for Tuberculosis Detection (World Health Organization, 2024); https://www.who.int/publications/i/item/9789240089488

  • Nsawotebba, A. et al. Impact of randomized blinded rechecking program on the performance of the AFB Microscopy Laboratory Network in Uganda: a decadal retrospective study. BMC Infect. Dis. 23, 494 (2023).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Otero, L. et al. Quality assessment of smear microscopy by stratified lot sampling of treatment follow-up slides. Int. J. Tuberc. Lung Dis. 15, 211–216 (2011).

    PubMed 

    Google Scholar
     

  • Mekonen, A. et al. Factors which contributed for low quality sputum smears for the detection of acid fast bacilli (AFB) at selected health centers in Ethiopia: a quality control perspective. PLoS ONE 13, e0198947 (2018).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Desalegn, D. M. et al. Misdiagnosis of pulmonary tuberculosis and associated factors in peripheral laboratories: a retrospective study, Addis Ababa, Ethiopia. BMC Res. Notes 11, 291 (2018).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Murongazvombo, A. S. et al. Where, when, and how many tuberculosis patients are lost from presumption until treatment initiation? A step by step assessment in a rural district in Zimbabwe. Int. J. Infect. Dis. 78, 113–120 (2019).

    Article 
    PubMed 

    Google Scholar
     

  • Chihota, V. N. et al. Missed opportunities for TB investigation in primary care clinics in South Africa: experience from the XTEND trial. PLoS ONE 10, e0138149 (2015).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Dorfman, D. D. & Alf, E. Jr Maximum-likelihood estimation of parameters of signal-detection theory and determination of confidence intervals—rating-method data. J. Math. Psychol. 6, 487–496 (1969).

    Article 

    Google Scholar
     

  • Abebe, G. et al. Evaluation of the 2007 WHO guideline to diagnose smear negative tuberculosis in an urban hospital in Ethiopia. BMC Infect. Dis. 13, 427 (2013).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Alamo, S. T. et al. Performance of the new WHO diagnostic algorithm for smear-negative pulmonary tuberculosis in HIV prevalent settings: a multisite study in Uganda. Trop. Med. Int. Health 17, 884–895 (2012).

    Article 
    PubMed 

    Google Scholar
     

  • Huerga, H. et al. Performance of the 2007 WHO algorithm to diagnose smear-negative pulmonary tuberculosis in a HIV prevalent setting. PLoS ONE 7, e51336 (2012).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Koole, O. et al. Evaluation of the 2007 WHO guideline to improve the diagnosis of tuberculosis in ambulatory HIV-positive adults. PLoS ONE 6, e18502 (2011).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Siddiqi, K., Walley, J., Khan, M. A., Shah, K. & Safdar, N. Clinical guidelines to diagnose smear-negative pulmonary tuberculosis in Pakistan, a country with low-HIV prevalence. Trop. Med. Int. Health 11, 323–331 (2006).

    Article 
    PubMed 

    Google Scholar
     

  • Soto, A. et al. Validation of a clinical–radiographic score to assess the probability of pulmonary tuberculosis in suspect patients with negative sputum smears. PLoS ONE 6, e18486 (2011).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Swai, H. F., Mugusi, F. M. & Mbwambo, J. K. Sputum smear negative pulmonary tuberculosis: sensitivity and specificity of diagnostic algorithm. BMC Res. Notes 4, 475 (2011).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Wilson, D. et al. Evaluation of the World Health Organization algorithm for the diagnosis of HIV-associated sputum smear-negative tuberculosis. Int. J. Tuberc. Lung Dis. 15, 919–924 (2011).

    Article 
    PubMed 

    Google Scholar
     

  • R Core Team. R: A Language and Environment for Statistical Computing (R Foundation for Statistical Computing, 2010).

  • Rstan: the R interface to Stan. R package 2.21.8 ed (Stan Development Team, 2023).

  • Menzies, N. Analysis code and data inputs for ‘The potential number of false-positive and false-negative TB diagnoses in low- and middle-income countries: a Bayesian analysis of routine reporting data’. Zenodo https://doi.org/10.5281/zenodo.16414104 (2025).

  • Source link

    Get RawNews Daily

    Stay informed with our RawNews daily newsletter email

    Jim Carrey Butt Birth Mechanical Rhino From ‘Ace Ventura’ Up For Auction

    Poll: Will JJ Wetherholt Break Camp With The Cardinals?

    Luci4 Had ‘Erratic Behavior’ at LAX Night Before Death, Cops Tell Family

    Line-ups, stats and preview including TV, live stream, team news and Premier League prediction