Thinking Beyond Diagnostic Accuracy to Evaluate Tuberculosis Screening Tests

Tuberculosis is a leading cause of morbidity and mortality among people living with HIV.1 Diagnosing tuberculosis in people living with HIV is often challenging, but even tests with moderate accuracy can be helpful when deployed in an appropriate diagnostic algorithm. For example, a urine lateral flow lipoarabinomannan assay can moderately decrease all-cause mortality risk among severely ill hospitalised people living with HIV,2 and its sensitivity is, at most, 50–60%.3 Tests that can readily detect tuberculosis disease and rapidly lead to further action, including treatment initiation, will greatly aid those at risk of tuberculosis, particularly people living with HIV initiating antiretroviral therapy, whose risk of incident tuberculosis is highly elevated during the first few months of the therapy.