Well-designed clinical trials are needed to strengthen the evidence about the accuracy, effectiveness (including the impact on patient-important outcomes such as mortality), feasibility and cost implications of using the W4SS, CRP, CXR and mWRD to screen for TB across all HIV subpopulations in settings with low, medium and high burdens of HIV and TB with and without high ART coverage.
Subpopulations of people living with HIV for whom further investigation is required would include, but not be limited to, inpatients, acute care service attendees, patients for whom ART has failed, patients newly diagnosed as HIV-positive enrolling in ART clinics, stable patients established on ART, pregnant women and children and adolescents living with HIV.
More data are needed on the effectiveness, cost–effectiveness, feasibility and acceptability, frequency and optimal periodicity of routine, regular screening with the W4SS, CRP, CXR and mWRD among people living with HIV. Specifically, more studies are needed that explore the optimal placement of mWRDs for screening in antenatal care settings versus within ART clinics. Lastly, more research is needed on the potential for screening people living with HIV with mWRDs using specimens other than sputum.