Diagnostic accuracy of screening and diagnostic tests used in a state-wide tuberculosis prevalence survey in India

Giridharan, Prathiksha and Inbaraj, Leeberk Raja and Selvaraju, Sriram and Ramraj, Balaji and Thiruvengadam, Kannan and Daniel, Bella Devaleenal and Padmapriyadarsini, Chandrasekaran (2025) Diagnostic accuracy of screening and diagnostic tests used in a state-wide tuberculosis prevalence survey in India. Diagnostic accuracy of screening and diagnostic tests used in a state-wide tuberculosis prevalence survey in India, 15 (9305).

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Abstract

Prevalence surveys and active case findings for tuberculosis (TB) typically use symptoms and Chest X-ray for screening and a diagnostic test for microbiological confirmation. We report the performance of screening and diagnostic tests from a state-wide prevalence survey in India. We screened 130,932 individuals using chest X-ray (CXR) and symptom checklist. Sputum samples were obtained from eligible participants and subjected to Xpert/MTB RIF, smear microscopy, and culture. Cough over two weeks had higher sensitivity (41.6%, 95% CI: 31.6–52.1) and lower specificity (72.8%, 95% CI: 72.1–73.5) among all the symptoms. The sensitivity and specificity of abnormal CXR were 86.4% (95% CI:77.9–92.5) and 42.12% (95% CI, 41.3–42.8), respectively. Xpert/MTB RIF in the reference laboratory had the highest sensitivity (96.55% 95% CI: 88.0-99.5), and smear microscopy had the highest specificity (99.7% 95% CI: 99.6–99.8). The combined sensitivity and specificity of Xpert MTB/RIF along symptom screening and CXR were 97.9% (95% CI:92.6–99.7) and 4.9% (95% CI:4.67–5.33), respectively. The mobile van Xpert MTB/RIF was found to be highly specific (99.3%). We recommend a diagnostic algorithm consisting of symptom screening and CXR followed by WHO-recommended rapid molecular assays (mWRD) for future prevalence surveys and active case finding.

Affiliation:	ICMR-National Institute for Research in Tuberculosis
Item Type:	Article
Uncontrolled Keywords:	Diagnostic test accuracy, Prevalence surveys, Active case finding, Xpert MTB/RIF
Subjects:	Tuberculosis > Clinical Research Tuberculosis
Divisions:	Epidemiology
Depositing User:	Mrs. N Lakshmi
Date Deposited:	27 Mar 2025 17:16
Last Modified:	27 Mar 2025 17:16
URI:	http://eprints.nirt.res.in/id/eprint/2026

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