Table 1– The performance of different diagnostic tests, stratified by HIV status, alone or in combination for the detection of tuberculosis (TB)
Frontline performance in all TB suspects#
All patientsHIV uninfected+HIV infected§All patientsHIV uninfected+HIV infected§
Sensitivity %ƒ (95% CI) n/NSpecificity %## (95% CI) n/NSensitivity %ƒ (95% CI) n/NSpecificity %## (95% CI) n/NSensitivity %ƒ (95% CI) n/NSpecificity %## (95% CI) n/NPPV
(95% CI) n/N		NPV
(95% CI) n/N		PPV
(95% CI) n/N		NPV
(95% CI) n/N		PPV
(95% CI) n/N		NPV
(95% CI) n/N
Xpert MTB/RIF77.2
(69.8–83.2) 115/149		95.5
(92.7–97.2) 316/331		81.0
(71.3–87.9) 68/84		95.1
(91.2–97.3) 193/203		70.0
(56.3–80.9) 35/50		95.0
(87.8–98.0) 76/80		88.5
(81.8–93.2) 115/130		90.3
(86.7–93.0) 316/350		87.2
(78.0–92.9) 68/79		92.3
(87.9–95.2) 193/209		89.7
(76.4–95.4) 35/39		83.5
(74.6–89.8) 76/91
Smear microscopy68.5
(60.6–75.4) 102/149		99.1
(97.4–99.7) 328/331		77.4
(67.4–85.0) 65/84		99.0
(96.5–99.7) 200/202		52.0
(38.5–65.2) 26/50		98.8
(93.3–99.8) 79/80		97.1
(91.9–99.0) 102/105		87.5
(83.7–90.4) 328/375		97.0
(89.8–99.2) 65/67		91.3
(86.9–94.4) 200/219		96.3
(81.7–99.3) 26/27		76.7
(67.7–83.8) 79/103
Smear microscopy followed by Xpert MTB/RIF¶¶81.9
(74.9–87.2) 122/149		94.9
(91.9–96.8) 314/331		85.7
(76.7–91.6) 72/84		95.1
(91.1–97.3) 192/202		74.0
(60.5–84.1) 37/50		93.8
(86.2–97.3) 75/80		87.8
(81.3–92.2) 122/139		92.1
(88.7–94.5) 314/341		87.8
(79.0–93.2) 72/82		94.1
(90.0–96.6) 192/204		88.1
(75.0–94.8) 37/42		85.2
(76.4–91.2) 75/88
CXR for active TB100
(96.5–100) 106/106		26.2
(20.8–32.4) 57/218		100
(93.9–100) 59/59		28.7
(21.6–37.0) 37/129		100
(90.6–100) 37/37		27.3
(17.3–40.2) 15/55		39.7
(34.0–46.7) 106/267		100
(93.7–100) 57/57		39.1
(31.7–47.0) 59/151		100
(90.6–100) 37/37		48.1
(37.3–59.0) 37/77		100
(79.6–100) 15/15
CXR followed by Xpert MTB/RIF++77.4
(68.5–84.3) 82/106		96.8
(93.5–98.4) 211/218		83.1
(71.5–90.5) 49/59		96.1
(91.3–98.3) 124/129		64.9
(48.8–78.2) 24/37		98.2
(90.4–99.7) 54/55		92.1
(84.6–96.1) 82/89		89.8
(85.3–93.0) 211/235		90.7
(80.1–96.0) 49/54		92.5
(86.8–95.9) 124/134		96.0
(80.5–99.3) 24/25		80.6
(69.6–88.3) 54/67
Smear microscopy followed by CXR¶¶ followed by Xpert MTB/RIF++83.0
(74.8–89.0) 88/106		96.3
(93.9–98.1) 210/218		89.8
(79.5–95.3) 53/59		96.1
(91.3–98.3) 124/129		67.6
(51.5–80.4) 25/37		96.4
(87.7–99.0) 53/55		91.7
(84.4–95.7) 88/96		92.1
(87.9–95.0) 210/228		91.4
(81.4–96.3) 53/58		95.3
(90.3–97.9) 124/130		92.6
(76.6–97.9) 25/27		81.5
(70.5–89.1) 53/65
CXR followed by smear microscopy++ followed by Xpert MTB/RIF¶¶83.0
(74.8–89.0) 88/106		96.3
(93.9–98.1) 210/218		89.8
(79.5–95.3) 53/59		96.1
(91.3–98.3) 124/129		67.6
(51.5–80.4) 25/37		96.4
(87.7–99.0) 53/55		91.7
(84.4–95.7) 88/96		92.1
(87.9–95.0) 210/228		91.4
(81.4–96.3) 53/58		95.3
(90.3–97.9) 124/130		92.6
(76.6–97.9) 25/27		81.5
(70.5–89.1) 53/65
Smear microscopy followed by Xpert MTB/RIF¶¶ and CXR§§100
(96.5–100) 106/106		25.7
(20.3–31.9) 56/218		100
(93.9–100) 59/59		27.9
(20.9–36.2) 36/129		100
(90.6–100) 37/37		28.3
(18.0–41.6) 15/53		39.6
(33.9–45.5) 106/268		100
(93.6–100) 56/56		38.8
(31.4–46.8) 59/152		100
(90.4–100) 36/36		49.3
(38.3–60.4) 37/75		100
(79.6–100) 15/15
T-SPOT.TB85.0
(77.1–90.6) 91/107		43.6
(37.4–50.0) 102/234		85.9
(75.4–92.4) 55/64		32.6
(25.5–40.7) 47/144		82.4
(66.5–91.7) 28/34		64.9
(51.9–76.0) 37/57		40.8
(34.6–47.4) 91/223		86.4
(79.1–91.5) 102/118		36.2
(29.0–44.1) 55/152		83.9
(72.2–91.3) 47/56		58.3
(44.3–71.2) 28/48		86.1
(72.7–93.4) 37/43
QFT-GIT84.9
(76.9–90.5) 90/106		40.2
(34.2–46.5) 96/239		87.7
(77.6–93.6) 57/65		34.6
(37.6–42.3) 55/159		80.6
(63.7–90.8) 25/31		57.8
(43.3–71.0) 26/45		38.6
(32.6–45.0) 90/233		85.7
(78.1–91.0) 96/112		35.4
(28.4–43.1) 57/161		87.3
(76.9–93.4) 55/63		56.8
(42.2–71.0) 25/44		81.3
(64.7–91.1) 26/32

  • PPV: positive predictive value; NPV: negative predictive value; CXR: chest radiograph; QFT-GIT: QuantiFERON-TB Gold In-Tube (Cellestis, Chadstone, Australia). T-SPOT-TB is manufactured by Oxford Immunotec Ltd, Oxford, UK. #: liquid culture positivity for Mycobacterium tuberculosis served as a reference standard. : n=480. +: n=286, 64 were of unknown HIV status (test refused or data missing). §: n=130, 64 were of unknown HIV status (test refused or data missing). ƒ: calculated by dividing the number of individuals positive for the adjunct test(s) by the number of culture-positive individuals who had received the same adjunct test(s); not all individuals received the same combination of tests. ##: calculated by dividing the number of culture-negative individuals negative for the adjunct test(s) by the number of culture-negative individuals who received the same adjunct test(s) (i.e. both probable and non-TB groups were included); not all individuals received the same combination of tests. ¶¶: performed if smear negative. ++: performed if CXR compatible with active TB. §§: performed if MTB/RIF-negative.