MacPherson P, Webb EL, Kamchedzera W, et al. - A significant increase in the timeliness and completeness of HIV and tuberculosis (TB) diagnosis was conferred by computer-aided digital chest X-ray (DCXR-CAD) with universal HIV screening. If implemented at scale, TB and HIV diagnosis and treatment may potentially be improved rapidly and efficiently.

• A total of 1,462 adults attending a primary clinic in Blantyre, Malawi with cough were included.

• They were randomised (1:1:1) to standard of care (SOC); oral HIV testing (HIV screening) and linkage to care; or HIV testing and linkage to care plus DCXR-CAD with sputum Xpert for high CAD4TBv5 scores (HIV-TB screening).

• They were followed for 56 days to determine initiation of TB treatment, missed TB and HIV diagnosis, and cost-effectiveness.

• The HIV-TB screening arm had a shorter (1 day) median time to TB treatment initiation vs the SOC arm (11 days) and HIV screening arm (6 days).

• Undiagnosed/untreated HIV was reduced due to HIV screening; from 10 (2.7%) in the SOC arm to 2 (0.5%) in the HIV screening arm and 1 (0.2%) in the HIV-TB screening arm.

• Trial follow-up (56 days) indicate likely cost-effectiveness of oral HIV testing and linkage to care but not of digital chest X-ray with computer-aided interpretation.