Fig. 3.

Forest plots of TB-LAMP diagnostic accuracy, best reference standard. The figures show the sensitivity and specificity of TB-LAMP in individual studies in reference to the best available reference standard for TB-LAMP as an alternative test for smear microscopy in all patients (Panel 3A), TB-LAMP as an alternative test for smear microscopy in HIV-positive adults (Panel 3B), and TB-LAMP as an add-on test following smear microscopy (Panel 3C). All reference standards classify patients as having TB if ≥1 positive culture was confirmed as M. tuberculosis by speciation testing. To be classified as not having TB, patients were required to have no positive and at least 1) two negative cultures on two different sputum specimens (Standard 1); or 2) two negative cultures on the same or different sputum specimens (Standard 2). Visual inspection of all three forest plots indicates considerable heterogeneity in sensitivity estimates but less heterogeneity in specificity estimates