It is important to balance the risks of over-diagnosis which will delay proper treatment of the patient and produce undue costs with the possibility of under-diagnosis which can lead to continued transmission and increased morbidity and mortality, especially in people living with HIV.
The WHO developed algorithm for clinical diagnosis does not perform equally in all settings
Diagnosing patients with negative smear or Xpert MTB/RIF results will require clinicians to adapt to local epidemiology and the financial needs and specific situation of the patient.