Jaganath D. auteur aut IRD Nabeta P. auteur aut IRD Nicol M. P. auteur aut IRD Castro R. auteur aut IRD Wambi P. auteur aut IRD Zar H. J. auteur aut IRD Workman L. auteur aut IRD Lodha R. auteur aut IRD Singh U. B. auteur aut IRD Bavdekar A. auteur aut IRD Sanghavi S. auteur aut IRD Trollip A. auteur aut IRD Mace A. auteur aut IRD Bonnet Maryline auteur aut IRD Lounnas Manon auteur aut IRD de Haas P. auteur aut IRD Tiemersma E. auteur aut IRD Alland D. auteur aut IRD Banada P. auteur aut IRD Cattamanchi A. auteur aut IRD Ruhwald M. auteur aut IRD Wobudeya E. auteur aut IRD Denkinger C. M. auteur aut IRD text journalArticle eng text/pdf born digital access Background Centrifuge-free processing methods support stool Xpert Ultra testing for childhood tuberculosis, but data on their accuracy, acceptability, and usability are limited.Methods We conducted a prospective evaluation of stool Xpert Ultra in India, South Africa, and Uganda with 3 methods: the Stool Processing Kit (SPK), the Simple One-Step method (SOS), and the Optimized Sucrose Flotation method (OSF). Children <15 years old with presumptive tuberculosis underwent sputum testing with Xpert Ultra and culture. We compared the accuracy of each method against a microbiological reference standard (tuberculosis if Xpert Ultra or culture positive) and a composite reference standard (tuberculosis if confirmed or unconfirmed tuberculosis). We surveyed laboratory staff to assess the acceptability and usability of the methods.Results We included 607 children, with a median age of 3.5 years (interquartile range, 1.3-7 years); 15.5% were human immunodeficiency virus positive. Against 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%). The methods were acceptable and usable, but SOS was reported as most feasible to implement in a peripheral facility. Across 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. Adding stool Xpert Ultra increased sensitivity from 0% (OSF) to 11.8% (SPK/SOS), compared with sputum alone.Conclusions Stool processing methods for Xpert Ultra were acceptable and usable and performed similarly, with highest sensitivity among children with culture-positive tuberculosis. specialized child tuberculosis diagnostics stool Xpert Ultra 050 052 [Early access] [9 ] 2025 1058-4838 https://www.documentation.ird.fr/hor/fdi:010094444 10.1093/cid/ciaf289 1058-4838 [F B010094444] https://www.documentation.ird.fr/hor/fdi:010094444 https://www.documentation.ird.fr/intranet/publi/2025-09/010094444.pdf Accès réservé (Intranet de l'IRD) IRD - Base Horizon / Pleins textes 2025-09-24 2026-06-12 fdi:010094444 fre