1. Summary characteristics of included studies.
| Study | Participants (% symptom) | Setting | Median CD4 cell count per µL (IQR) | TB prevalence % (n/N) | Did the study avoid inappropriate exclusion? | Specimens collected | High‐quality reference standarda | Unique study characteristics |
| HIV‐positive adults with signs and symptoms of TB | ||||||||
| Drain 2016 | Symptomatic: Two of four TB‐related symptoms (cough, fever weight loss, night sweat) for > 2 weeks; smear microscopy negative x 2 | Outpatient | 168 (89 to 256) | 63% (57/90) | No | Pulmonary samples | No | Adults (> 18 years); HIV positive (93.2%); targeting a relatively well outpatient population; Karnofsky performance score > 50 |
| Huerga 2017 |
Symptomatic: Cough > 2 weeks or any cough and one of weight loss, night sweats or fever; severely ill; CD4< 200 or BMI below 17 |
Outpatients (33%); Inpatients (67%) | 109 (43 to 214) | 57% (156/275) | No | Pulmonary samples; urine Xpert only for patients without sputum available | No | Adults (> 15 years); LAM‐guided treatment; excluded many participants from analysisb |
| Juma 2017 |
Symptomatic: Suggestive of extrapulmonary TB, not specified |
Inpatients | Not stated | 33% (29/67) | No | Extrapulmonary samples only, no sputum samples | No | Adults (> 14 years), HIV‐positive (68%); excluded patients with concomitants active pulmonary TB |
| Nakiyingi 2014 |
Symptomatic: Any of cough, fever weight loss, night sweat |
Outpatients (45%); Inpatients (55%) | 152 (41 to 337) | 37% (367/997) | No | Pulmonary samples; Blood culture for all | Yes | Adults (> 18 years); multisite; large sample size. |
| Pandie 2016 |
Symptomatic: Presence of a pericardial effusion and suspected of pericardial TB |
Inpatients | 139 (81 to 249) | 95% (36/38) | No | Extrapulmonary samples (pericardial effusion); pulmonary samples for some | No | Adults (> 18 years); HIV‐positive (74%); excluded participants from analysis affecting specificityc |
| Peter 2012a |
Symptomatic: Any of cough, fever weight loss, night sweat |
Inpatients | 90 (47 to 197) | 48% (116/241) | Yes | Clinically relevant pulmonary samples; clinically relevant extrapulmonary samples. No study defined algorithm. | No | Adults (> 18 years); multisite; TB diagnostic work‐up was not standardized but up to clinical judgements |
| Peter 2015 |
Symptomatic: Any of cough, fever weight loss, night sweat |
Outpatients | 210 (103 to 375) | 32% (181/569) | No | Pulmonary samples | No | Adults (> 18 years); multisite; nested within a randomized, parallel‐arm trial. |
| Peter 2016 |
Symptomatic: Any of cough, fever weight loss, night sweat |
Inpatients | 81 (26 to 198) |
29% (342/1172) | Yes | Pulmonary samples; clinically relevant extrapulmonary samples. No study defined algorithm. | No | Adults (> 18 years); multisite; LAM arm of a randomized controlled trial. |
| HIV‐positive adults irrespective of signs and symptoms of TB | ||||||||
| Bjerrum 2015 |
Unselected: 91% symptomatic |
Outpatients (85%); Inpatients (15%) | 127 (35 to 256) | 12% (55/469) | No | Pulmonary samples | No | Adults (> 18 years); majority symptomatic. |
| Drain 2015a |
Unselected: proportion symptomatic not stated |
Outpatient | 248 (107 to 379) | 17% (54/320) | No | Pulmonary samples | No | Adults (> 18 years) |
| Floridia 2017 |
Unselected: 34% symptomatic |
Outpatient | 278 (142 to 395) | 9% (90/972) | No | Pulmonary samples | No | Adults (> 15 years). LAM‐guided treatment. |
| Hanifa 2016 |
Unselected: 53% symptomatic |
Outpatient | 111 (56 to 161) | 9% (40/408) | Yes | Pulmonary samples; blood culture for all | Yes | Adults (> 18 years); CD4 < 200; reference standard included any sample taken within six months from enrolment. |
| LaCourse 2016 |
Unselected: 19% symptomatic |
Outpatient | 437 (342 to 565) | 1% (3/266) | No | Pulmonary samples | No | Pregnant women (> 16 years) attending ANC; healthy population; one person with CD4< 400; Few TB cases (n = 3). |
| Lawn 2017 |
Unselected: 91% symptomatic |
Inpatients | 149 (55‐312) | 33% (139/413) | Yes | Pulmonary samples; Blood culture for all; Clinically relevant extrapulmonary samples | Yes | Adults (> 18 years). Included many samples from different sites |
| Thit 2017 |
Unselected: 33% symptomatic |
Outpatients (90%); Inpatients (10%) | 270 (128 to 443) | 10% (54/517) | Yes | Pulmonary samples | No | Conducted in Myanmar. Adults (median age 34). Reference standard included samples taken within six months from enrolment. |
Abbreviations: LF‐LAM: lateral flow urine lipoarabinomannan assay (Alere Determine™ TB lipoarabinomannan assay); ANC: antenatal clinic; BMI: body mass index; IQR: interquartile range; TB: tuberculosis; Xpert: Xpert MTB/RIF aFor a microbiological reference standard, we considered a higher quality reference standard to be one in which two or more specimen types were evaluated for TB diagnosis in all participants as part of a defined standardized study algorithm. bHuerga 2017 excluded participants from analysis if missing Xpert results or culture contaminated for any of the samples in the absence of a positive result; overall samples size 474 (156 with TB); 275 included in analysis (156 with TB). cPandie 2016 excluded a large number of non‐TB participants from analysis; Overall samples size 102 (36 with TB); 38 included for analysis (36 TB cases).