{"id":"https://openalex.org/W7167339136","doi":"https://doi.org/10.64898/2026.07.02.26357020","title":"How can spectrum bias impact expectations of test performance: a secondary modeling study estimating novel swab-based test outcomes across populations","display_name":"How can spectrum bias impact expectations of test performance: a secondary modeling study estimating novel swab-based test outcomes across populations","publication_year":2026,"publication_date":"2026-07-04","ids":{"openalex":"https://openalex.org/W7167339136","doi":"https://doi.org/10.64898/2026.07.02.26357020"},"language":"en","primary_location":{"id":"doi:10.64898/2026.07.02.26357020","doi":"https://doi.org/10.64898/2026.07.02.26357020","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.07.02.26357020","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/07/04/2026.07.02.26357020.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/07/04/2026.07.02.26357020.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5055832296","display_name":"Sarah Zaidi","orcid":"https://orcid.org/0000-0003-3945-6251","observed_orcids":["https://orcid.org/0000-0003-3945-6251"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Sarah Zaidi","raw_affiliation_strings":["Stop TB Partnership, Geneva, Switzerland"],"raw_orcid":"https://orcid.org/0000-0003-3945-6251","affiliations":[{"raw_affiliation_string":"Stop TB Partnership, Geneva, Switzerland","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5082392295","display_name":"Tushar Garg","orcid":"https://orcid.org/0000-0002-6781-8574","observed_orcids":["https://orcid.org/0000-0002-6781-8574"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Tushar Garg","raw_affiliation_strings":["Stop TB Partnership, Geneva, Switzerland"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Stop TB Partnership, Geneva, Switzerland","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5125895858","display_name":"Luan Nguyen Quang Vo","orcid":"https://orcid.org/0000-0002-5937-6286","observed_orcids":["https://orcid.org/0000-0002-5937-6286"]},"institutions":[{"id":"https://openalex.org/I28166907","display_name":"Karolinska Institutet","ror":"https://ror.org/056d84691","country_code":"SE","type":"education","lineage":["https://openalex.org/I28166907"]}],"countries":["SE"],"is_corresponding":false,"raw_author_name":"Luan Nguyen Quang Vo","raw_affiliation_strings":["Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden","Friends for International TB Relief, Hanoi, Viet Nam"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden","institution_ids":["https://openalex.org/I28166907"]},{"raw_affiliation_string":"Friends for International TB Relief, Hanoi, Viet Nam","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5133737793","display_name":"Melissa Sander","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Melissa Sander","raw_affiliation_strings":["Center for Health Promotion and Research (CHPR), Bamenda, Cameroon"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Center for Health Promotion and Research (CHPR), Bamenda, Cameroon","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5134984009","display_name":"Andrew J. Codlin","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I28166907","display_name":"Karolinska Institutet","ror":"https://ror.org/056d84691","country_code":"SE","type":"education","lineage":["https://openalex.org/I28166907"]}],"countries":["SE"],"is_corresponding":false,"raw_author_name":"Andrew James Codlin","raw_affiliation_strings":["Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden","Friends for International TB Relief, Hanoi, Viet Nam"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden","institution_ids":["https://openalex.org/I28166907"]},{"raw_affiliation_string":"Friends for International TB Relief, Hanoi, Viet Nam","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5003676627","display_name":"Rachel Louise Byrne","orcid":"https://orcid.org/0000-0001-5398-3125","observed_orcids":["https://orcid.org/0000-0001-5398-3125"]},"institutions":[{"id":"https://openalex.org/I146655781","display_name":"University of Liverpool","ror":"https://ror.org/04xs57h96","country_code":"GB","type":"education","lineage":["https://openalex.org/I146655781"]},{"id":"https://openalex.org/I194839184","display_name":"Liverpool School of Tropical Medicine","ror":"https://ror.org/03svjbs84","country_code":"GB","type":"funder","lineage":["https://openalex.org/I194839184"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Rachel Louise Byrne","raw_affiliation_strings":["Centre for Tuberculosis Research, Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK","Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Centre for Tuberculosis Research, Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK","institution_ids":["https://openalex.org/I146655781","https://openalex.org/I194839184"]},{"raw_affiliation_string":"Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK","institution_ids":["https://openalex.org/I194839184"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5085137678","display_name":"Vibol Iem","orcid":"https://orcid.org/0000-0001-6155-1402","observed_orcids":["https://orcid.org/0000-0001-6155-1402"]},"institutions":[{"id":"https://openalex.org/I146655781","display_name":"University of Liverpool","ror":"https://ror.org/04xs57h96","country_code":"GB","type":"education","lineage":["https://openalex.org/I146655781"]},{"id":"https://openalex.org/I194839184","display_name":"Liverpool School of Tropical Medicine","ror":"https://ror.org/03svjbs84","country_code":"GB","type":"funder","lineage":["https://openalex.org/I194839184"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Vibol Iem","raw_affiliation_strings":["Centre for Tuberculosis Research, Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK","Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Centre for Tuberculosis Research, Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK","institution_ids":["https://openalex.org/I146655781","https://openalex.org/I194839184"]},{"raw_affiliation_string":"Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK","institution_ids":["https://openalex.org/I194839184"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5037285420","display_name":"Sayera Banu","orcid":"https://orcid.org/0000-0002-5121-1962","observed_orcids":["https://orcid.org/0000-0002-5121-1962"]},"institutions":[{"id":"https://openalex.org/I205889620","display_name":"International Centre for Diarrhoeal Disease Research","ror":"https://ror.org/04vsvr128","country_code":"BD","type":"facility","lineage":["https://openalex.org/I205889620"]}],"countries":["BD"],"is_corresponding":false,"raw_author_name":"Sayera Banu","raw_affiliation_strings":["icddr,b, Dhaka, Bangladesh"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"icddr,b, Dhaka, Bangladesh","institution_ids":["https://openalex.org/I205889620"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5134972647","display_name":"John Bimba","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I201292520","display_name":"Bingham University","ror":"https://ror.org/04dbvvk55","country_code":"NG","type":"education","lineage":["https://openalex.org/I201292520"]}],"countries":["NG"],"is_corresponding":false,"raw_author_name":"John Bimba","raw_affiliation_strings":["Zankli Research Centre, Bingham University, Karu, Nigeria"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Zankli Research Centre, Bingham University, Karu, Nigeria","institution_ids":["https://openalex.org/I201292520"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5051472291","display_name":"Victor Santana Santos","orcid":"https://orcid.org/0000-0003-0194-7397","observed_orcids":["https://orcid.org/0000-0003-0194-7397"]},"institutions":[{"id":"https://openalex.org/I190085865","display_name":"Universidade Federal de Sergipe","ror":"https://ror.org/028ka0n85","country_code":"BR","type":"education","lineage":["https://openalex.org/I190085865"]}],"countries":["BR"],"is_corresponding":false,"raw_author_name":"Victor Santana Santos","raw_affiliation_strings":["Department of Medicine, Federal University of Sergipe, Lagarto, Brazil"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Medicine, Federal University of Sergipe, Lagarto, Brazil","institution_ids":["https://openalex.org/I190085865"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5072284686","display_name":"Cyrille  Ndamnsah Mbuli","orcid":"https://orcid.org/0000-0001-9564-6311","observed_orcids":["https://orcid.org/0000-0001-9564-6311"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Cyrille Mbuli","raw_affiliation_strings":["Center for Health Promotion and Research (CHPR), Bamenda, Cameroon"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Center for Health Promotion and Research (CHPR), Bamenda, Cameroon","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5132546738","display_name":"Han Thi Nguyen","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I28166907","display_name":"Karolinska Institutet","ror":"https://ror.org/056d84691","country_code":"SE","type":"education","lineage":["https://openalex.org/I28166907"]}],"countries":["SE"],"is_corresponding":false,"raw_author_name":"Han Thi Nguyen","raw_affiliation_strings":["Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden","FIT RD Social Enterprise Company Limited (FIT RD), Hanoi, Viet Nam"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden","institution_ids":["https://openalex.org/I28166907"]},{"raw_affiliation_string":"FIT RD Social Enterprise Company Limited (FIT RD), Hanoi, Viet Nam","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5031097700","display_name":"Augustine Talumba Choko","orcid":"https://orcid.org/0000-0001-6095-9430","observed_orcids":["https://orcid.org/0000-0001-6095-9430"]},"institutions":[{"id":"https://openalex.org/I146655781","display_name":"University of Liverpool","ror":"https://ror.org/04xs57h96","country_code":"GB","type":"education","lineage":["https://openalex.org/I146655781"]},{"id":"https://openalex.org/I194839184","display_name":"Liverpool School of Tropical Medicine","ror":"https://ror.org/03svjbs84","country_code":"GB","type":"funder","lineage":["https://openalex.org/I194839184"]},{"id":"https://openalex.org/I2799451200","display_name":"Malawi-Liverpool-Wellcome Trust Clinical Research Programme","ror":"https://ror.org/03tebt685","country_code":"MW","type":"facility","lineage":["https://openalex.org/I157591606","https://openalex.org/I2799451200","https://openalex.org/I87048295"]}],"countries":["GB","MW"],"is_corresponding":false,"raw_author_name":"Augustine Choko","raw_affiliation_strings":["Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK","Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK","institution_ids":["https://openalex.org/I146655781","https://openalex.org/I194839184"]},{"raw_affiliation_string":"Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi","institution_ids":["https://openalex.org/I2799451200"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5021519963","display_name":"Steve Wandiga","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I2841861","display_name":"Kenya Medical Research Institute","ror":"https://ror.org/04r1cxt79","country_code":"KE","type":"facility","lineage":["https://openalex.org/I2841861"]}],"countries":["KE"],"is_corresponding":false,"raw_author_name":"Steve Wandiga","raw_affiliation_strings":["Kenya Medical Research Institute (KEMRI), Nairobi, Kenya"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Kenya Medical Research Institute (KEMRI), Nairobi, Kenya","institution_ids":["https://openalex.org/I2841861"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5134980690","display_name":"Stephen John","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Stephen John","raw_affiliation_strings":["Janna Health Foundation, Jimeta Yola, Adamawa State, Nigeria"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Janna Health Foundation, Jimeta Yola, Adamawa State, Nigeria","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5023828847","display_name":"S. Bertel Squire","orcid":"https://orcid.org/0000-0001-7173-9038","observed_orcids":["https://orcid.org/0000-0001-7173-9038"]},"institutions":[{"id":"https://openalex.org/I146655781","display_name":"University of Liverpool","ror":"https://ror.org/04xs57h96","country_code":"GB","type":"education","lineage":["https://openalex.org/I146655781"]},{"id":"https://openalex.org/I194839184","display_name":"Liverpool School of Tropical Medicine","ror":"https://ror.org/03svjbs84","country_code":"GB","type":"funder","lineage":["https://openalex.org/I194839184"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Bertie Squire","raw_affiliation_strings":["Centre for Tuberculosis Research, Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK","Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Centre for Tuberculosis Research, Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK","institution_ids":["https://openalex.org/I146655781","https://openalex.org/I194839184"]},{"raw_affiliation_string":"Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK","institution_ids":["https://openalex.org/I194839184"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5014886171","display_name":"Tom Wingfield","orcid":"https://orcid.org/0000-0001-8433-6887","observed_orcids":["https://orcid.org/0000-0001-8433-6887"]},"institutions":[{"id":"https://openalex.org/I146655781","display_name":"University of Liverpool","ror":"https://ror.org/04xs57h96","country_code":"GB","type":"education","lineage":["https://openalex.org/I146655781"]},{"id":"https://openalex.org/I194839184","display_name":"Liverpool School of Tropical Medicine","ror":"https://ror.org/03svjbs84","country_code":"GB","type":"funder","lineage":["https://openalex.org/I194839184"]},{"id":"https://openalex.org/I4405270996","display_name":"Liverpool University Hospitals NHS Foundation Trust","ror":"https://ror.org/01pd4a160","country_code":"GB","type":"healthcare","lineage":["https://openalex.org/I4405270996"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Tom Wingfield","raw_affiliation_strings":["Centre for Tuberculosis Research, Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK","Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Centre for Tuberculosis Research, Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK","institution_ids":["https://openalex.org/I146655781","https://openalex.org/I194839184"]},{"raw_affiliation_string":"Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK","institution_ids":["https://openalex.org/I4405270996"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5010284171","display_name":"Jacob Creswell","orcid":"https://orcid.org/0000-0002-4885-940X","observed_orcids":["https://orcid.org/0000-0002-4885-940X"]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Jacob Creswell","raw_affiliation_strings":["Stop TB Partnership, Geneva, Switzerland"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Stop TB Partnership, Geneva, Switzerland","institution_ids":[]}]}],"institutions":[],"countries_distinct_count":7,"institutions_distinct_count":9,"corresponding_author_ids":["https://openalex.org/A5010284171"],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10038","display_name":"Tuberculosis Research and Epidemiology","score":0.9937000274658203,"subfield":{"id":"https://openalex.org/subfields/2725","display_name":"Infectious Diseases"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10038","display_name":"Tuberculosis Research and Epidemiology","score":0.9937000274658203,"subfield":{"id":"https://openalex.org/subfields/2725","display_name":"Infectious Diseases"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11754","display_name":"SARS-CoV-2 detection and testing","score":0.0005000000237487257,"subfield":{"id":"https://openalex.org/subfields/2725","display_name":"Infectious Diseases"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11314","display_name":"Clinical Laboratory Practices and Quality Control","score":0.00039999998989515007,"subfield":{"id":"https://openalex.org/subfields/2737","display_name":"Physiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/tuberculosis","display_name":"tuberculosis","score":0.5690000057220459},{"id":"https://openalex.org/keywords/xpert-mtb-rif","display_name":"Xpert MTB/RIF","score":0.9710000157356262},{"id":"https://openalex.org/keywords/xpert-mtb-rif-ultra","display_name":"Xpert MTB/RIF Ultra","score":0.968999981880188},{"id":"https://openalex.org/keywords/diagnostic-accuracy","display_name":"diagnostic accuracy","score":0.8429999947547913},{"id":"https://openalex.org/keywords/paucibacillary-tuberculosis","display_name":"paucibacillary tuberculosis","score":0.8579999804496765},{"id":"https://openalex.org/keywords/spectrum-bias","display_name":"spectrum bias","score":0.3630000054836273}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.7315999865531921},{"id":"https://openalex.org/C2776301714","wikidata":"https://www.wikidata.org/wiki/Q259346","display_name":"Sputum","level":3,"score":0.6987000107765198},{"id":"https://openalex.org/C2781069245","wikidata":"https://www.wikidata.org/wiki/Q12204","display_name":"Tuberculosis","level":2,"score":0.5680000185966492},{"id":"https://openalex.org/C2777267654","wikidata":"https://www.wikidata.org/wiki/Q3519023","display_name":"Test (biology)","level":2,"score":0.5091999769210815},{"id":"https://openalex.org/C105795698","wikidata":"https://www.wikidata.org/wiki/Q12483","display_name":"Statistics","level":1,"score":0.48829999566078186},{"id":"https://openalex.org/C82157600","wikidata":"https://www.wikidata.org/wiki/Q2671652","display_name":"Diagnostic test","level":2,"score":0.4259999990463257},{"id":"https://openalex.org/C2777975735","wikidata":"https://www.wikidata.org/wiki/Q130971","display_name":"Mycobacterium tuberculosis","level":3,"score":0.38179999589920044},{"id":"https://openalex.org/C2780639635","wikidata":"https://www.wikidata.org/wiki/Q4888238","display_name":"Tuberculosis diagnosis","level":4,"score":0.37400001287460327},{"id":"https://openalex.org/C3020132585","wikidata":"https://www.wikidata.org/wiki/Q2671652","display_name":"Diagnostic accuracy","level":2,"score":0.31060001254081726},{"id":"https://openalex.org/C2908628106","wikidata":"https://www.wikidata.org/wiki/Q12204","display_name":"Pulmonary tuberculosis","level":3,"score":0.2985000014305115},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.2791000008583069}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.07.02.26357020","doi":"https://doi.org/10.64898/2026.07.02.26357020","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.07.02.26357020","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/07/04/2026.07.02.26357020.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.07.02.26357020","doi":"https://doi.org/10.64898/2026.07.02.26357020","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.07.02.26357020","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/07/04/2026.07.02.26357020.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being","score":0.9537000060081482}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7167339136.pdf","grobid_xml":"https://content.openalex.org/works/W7167339136.grobid-xml"},"referenced_works_count":21,"referenced_works":["https://openalex.org/W1974091486","https://openalex.org/W2116226796","https://openalex.org/W2771791410","https://openalex.org/W2800206883","https://openalex.org/W2923306782","https://openalex.org/W2945083152","https://openalex.org/W3015027683","https://openalex.org/W3166201616","https://openalex.org/W4318338130","https://openalex.org/W4367609689","https://openalex.org/W4377940992","https://openalex.org/W4391467517","https://openalex.org/W4407307116","https://openalex.org/W4409480189","https://openalex.org/W4411222457","https://openalex.org/W4415317132","https://openalex.org/W4415751835","https://openalex.org/W7117118353","https://openalex.org/W7128914473","https://openalex.org/W7158776730","https://openalex.org/W7160237793"],"related_works":["https://openalex.org/W4415751835","https://openalex.org/W4410909779","https://openalex.org/W4416356257","https://openalex.org/W7160159534","https://openalex.org/W7117118353","https://openalex.org/W7148865655","https://openalex.org/W7221021799","https://openalex.org/W4225299832","https://openalex.org/W2147588959","https://openalex.org/W2733694143"],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"New":[2],"swab-based":[3],"near-point-of-care":[4],"(NPOC)":[5],"tests":[6,196,249],"offer":[7],"a":[8,82,132,254],"potentially":[9],"lower-cost,":[10],"simpler":[11],"alternative":[12],"to":[13,27,37,106,136,145,191,241,252],"Xpert":[14,61,92,138,181,242],"MTB/RIF":[15,62],"Ultra":[16,139],"(Xpert-Ultra)":[17],"testing":[18,51],"for":[19,76,91,156,162,228,276],"tuberculosis":[20],"(TB)":[21],"diagnosis.":[22],"However,":[23],"it":[24],"is":[25,269],"critical":[26],"understand":[28],"how":[29],"their":[30],"performance":[31,49,211],"may":[32],"differ":[33],"across":[34,119,290],"diverse":[35],"populations":[36],"inform":[38],"programmatic":[39],"rollout":[40],"and":[41,59,126,159,172,179,183,201,219,231],"real-world":[42,282],"clinical":[43],"decision-making.":[44],"Methods":[45],"We":[46],"modeled":[47],"the":[48,55,60,116,192,225,285,291],"of":[50,85,115,257,287,294],"sputum":[52,237],"swabs":[53,238],"with":[54,69,259],"MiniDock":[56,77,157,176,229,235],"MTB":[57,78,158,177,230,236],"assay":[58],"(Xpert)":[63],"using":[64,245],"positive":[65,108,203,222,261],"percentage":[66],"agreement":[67],"(PPA)":[68],"Xpert-Ultra,":[70],"disaggregated":[71,122],"by":[72,123],"semi-quantitative":[73,140,174],"grade.":[74],"PPA":[75,90,102,135,150],"was":[79,93,151],"derived":[80,94],"from":[81,95,97,112],"random-effects":[83],"meta-analysis":[84],"three":[86],"diagnostic":[87,100,277],"accuracy":[88,278],"studies.":[89],"data":[96],"an":[98,137],"early":[99],"study.":[101],"estimates":[103,188,275],"were":[104,189],"applied":[105,190],"1,248":[107],"Xpert-Ultra":[109,204,260],"test":[110],"results":[111,223,262],"Phase":[113],"1":[114],"Start4All":[117,193],"study":[118],"seven":[120],"countries,":[121],"facility-based":[124],"(n=1,033)":[125],"community-based":[127],"(n=215)":[128],"participant":[129],"recruitment,":[130],"comparing":[131],"single":[133,273],"overall":[134,149],"grade-stratified":[141,187,226,246],"model":[142,209,227],"(from":[143],"Trace":[144],"High).":[146],"Results":[147],"Pooled":[148],"84.8%":[152],"(95%":[153],"CI:":[154],"67.1\u201393.8%)":[155],"93.1%":[160],"(90.3\u201395.2%)":[161],"Xpert.":[163],"Grade-stratified":[164],"modeling":[165],"revealed":[166],"lower":[167],"PPAs":[168],"at":[169],"\u2018Very":[170],"Low\u2019":[171],"\u2018Trace\u2019":[173],"grades:":[175],"56.5%":[178],"33.8%;":[180],"66.7%":[182],"23.1%,":[184],"respectively.":[185,206,233],"When":[186],"data,":[194],"both":[195],"performed":[197],"similarly,":[198],"missing":[199],"241/1,248":[200],"228/1,248":[202],"results,":[205],"The":[207],"single-value":[208],"overestimated":[210],"most":[212],"markedly":[213],"in":[214,263],"community":[215,264],"settings,":[216,265],"predicting":[217],"10.8%":[218],"19.1%":[220],"more":[221,270],"than":[224],"Xpert,":[232],"Conclusion":[234],"perform":[239],"comparably":[240],"when":[243],"assessed":[244],"modeling.":[247],"Both":[248],"are":[250],"likely":[251],"miss":[253],"greater":[255],"proportion":[256],"people":[258],"where":[266],"paucibacillary":[267],"disease":[268],"common.":[271],"Using":[272],"point":[274],"can":[279],"substantially":[280],"overestimate":[281],"performance,":[283],"highlighting":[284],"importance":[286],"evaluating":[288],"diagnostics":[289],"full":[292],"spectrum":[293],"TB":[295],"disease.":[296]},"counts_by_year":[],"updated_date":"2026-10-28T10:33:24.094632","created_date":"2026-07-05T00:00:00"}