Cox 2014.

Study characteristics
Methods	Pragmatic prospective cluster‐randomized trial. The study took place in one large primary care facility, with randomization by week to the intervention or routine care.
Participants	Participants were presumptive pulmonary tuberculosis presenting at Ubuntu clinic in Khayelitisha Cape town; 18 years old and older Female: 44.7% in the Xpert group, and 46% in smear microscopy group HIV infection: 59% in Xpert group, 59.7% in smear microscopy group Setting: primary healthcare clinic Country: South Africa Sample size: 982 Xpert MTB/RIF arm, and 1003 smear microscopy arm
Interventions	Randomization was done on weekly basis. Each week during the study period was randomized to either Xpert MTB/RIF or smear microscopy Intervention: Xpert MTB/RIF Routine care: smear, culture and DST for high risk of drug resistance
Outcomes	Primary outcome: proportion of bacteriologically confirmed tuberculosis cases that had not initiated appropriate treatment by 3 months after enrolment Secondary outcomes: time to diagnosis, time to tuberculosis treatment, all‐cause mortality, the number of clinic visits prior to appropriate tuberculosis treatment
Notes	Target condition: tuberculosis case definition: bacteriological confirmation of tuberculosis (smear, Xpert, or culture)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Weeks during the study period were randomized to either intervention (Xpert MTB/RIF) or control (smear microscopy). Sequence was generated using web based (Random.org) system prior to the start of the study.
Allocation concealment (selection bias)	Unclear risk	The principal investigator generated the schedule list however no details on how and who kept the list
Baseline characteristics similar (selection bias)	Low risk	Characteristics were similar in both group
Blinding of participants and personnel (performance bias) All outcomes	High risk	The trial was not blinded
Protection against contamination (performance bias)	Unclear risk	Randomization was done weekly during the study weeks; the intervention was not always correctly assigned
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Outcomes were objectively assessed. It is unlikely that treatment initiation was done differently across group. Mortality was ascertained through regional and national registry, using civil identification numbers
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Proportion of unfavourable outcomes was reported in combination (defaulters, death, and failure). It is not clearly stated how much of the unfavourable outcome was linked to loss to follow‐up, and whether this affected the groups differently
Selective reporting (reporting bias)	Unclear risk	Some outcomes were not prespecified
Other bias	Low risk	No other biases were detected