@article{fdi:010094444,
  title = {{S}tool processing methods for xpert ultra testing in childhood tuberculosis: a prospective, multicountry accuracy study},
  author = {{J}aganath, {D}. and {N}abeta, {P}. and {N}icol, {M}. {P}. and {C}astro, {R}. and {W}ambi, {P}. and {Z}ar, {H}. {J}. and {W}orkman, {L}. and {L}odha, {R}. and {S}ingh, {U}. {B}. and {B}avdekar, {A}. and {S}anghavi, {S}. and {T}rollip, {A}. and {M}ace, {A}. and {B}onnet, {M}aryline and {L}ounnas, {M}anon and de {H}aas, {P}. and {T}iemersma, {E}. and {A}lland, {D}. and {B}anada, {P}. and {C}attamanchi, {A}. and {R}uhwald, {M}. and {W}obudeya, {E}. and {D}enkinger, {C}. {M}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {C}entrifuge-free processing methods support stool {X}pert {U}ltra testing for childhood tuberculosis, but data on their accuracy, acceptability, and usability are limited.{M}ethods {W}e conducted a prospective evaluation of stool {X}pert {U}ltra in {I}ndia, {S}outh {A}frica, and {U}ganda with 3 methods: the {S}tool {P}rocessing {K}it ({SPK}), the {S}imple {O}ne-{S}tep method ({SOS}), and the {O}ptimized {S}ucrose {F}lotation method ({OSF}). {C}hildren <15 years old with presumptive tuberculosis underwent sputum testing with {X}pert {U}ltra and culture. {W}e compared the accuracy of each method against a microbiological reference standard (tuberculosis if {X}pert {U}ltra or culture positive) and a composite reference standard (tuberculosis if confirmed or unconfirmed tuberculosis). {W}e surveyed laboratory staff to assess the acceptability and usability of the methods.{R}esults {W}e included 607 children, with a median age of 3.5 years (interquartile range, 1.3-7 years); 15.5% were human immunodeficiency virus positive. {A}gainst the microbiological reference standard, the sensitivities of {SPK}, {SOS}, and {OSF} were 36.9% (95% confidence interval, 28.6%-45.8%), 38.6% (17.2%-51.0%), and 31.3% (20.2%-44.1%), respectively, and the specificities, 98.2% (96.4%-99.3%), 97.3% (93.7%-99.1%), and 97.1% (93.3%-99%). {T}he methods were acceptable and usable, but {SOS} was reported as most feasible to implement in a peripheral facility. {A}cross methods, sensitivities increased among children who were culture positive (range, 55.0%-77.3%) and were low (13%-16.7%) against the composite reference standard. {A}dding stool {X}pert {U}ltra increased sensitivity from 0% ({OSF}) to 11.8% ({SPK}/{SOS}), compared with sputum alone.{C}onclusions {S}tool processing methods for {X}pert {U}ltra were acceptable and usable and performed similarly, with highest sensitivity among children with culture-positive tuberculosis.},
  keywords = {child ; tuberculosis ; diagnostics ; stool ; {X}pert {U}ltra},
  booktitle = {},
  journal = {{C}linical {I}nfectious {D}iseases},
  volume = {[{E}arly access]},
  numero = {},
  pages = {[9 p.]},
  ISSN = {1058-4838},
  year = {2025},
  DOI = {10.1093/cid/ciaf289},
  URL = {https://www.documentation.ird.fr/hor/fdi:010094444},
}