add 3 more weeks." The Xpert MTB/RIF Ultra improves upon the Xpert MTB/RIF test. LAM detection assays Tests based on the detection of mycobacterial lipoarabinomannan (LAM) antigen in urine have emerged as point-of-care tests for tuberculosis (TB). LAM antigen is a lipopolysaccharide present in mycobacterial cell walls, which is released from metabolically active or degenerating bacterial cells and appears to be present only in people with active TB disease. Urine-based testing have advantages over sputum-based testing because urine is easy to collect and store, and lacks the infection control risks associated with sputum collection. In 2015, WHO recommended the use of the Alere Determine TB LAM Ag assay for people with HIV and a CD4 count below 100 cells/μL and in those defined as seriously ill according to WHO criteria (respiratory rate >30 breaths per min, body temperature >39 °C, heart rate >120 beats per min, or unable to walk unaided). This recommendation was informed by a Cochrane systematic review and meta-analysis of 12 cross-sectional or cohort studies that showed a relatively low pooled sensitivity of 45% and specificity of 92% against a microbiological reference standard. Despite the limited sensitivity, test-guided initiation of anti-TB treatment reduced mortality in immunocompromised, hospitalized PLHIV. In 2019, an international R&D consortium including FIND, Fujifilm, University of Cape Town, Rutgers University, University of Alberta and Otsuka funded by GHIT completed the development and a first clinical study of the Fujifilm SILVAMP TB point-of-care LAM assay. Compared with the Alere Determine TB LAM Ag assay, the Fujifilm SILVAMP TB LAM assay includes novel monoclonal antibodies directed towards the 5-methylthio-d-xylofuranose (MTX) epitope and a silver amplification technology to enable higher diagnostic sensitivity at high specificity. A study with 968 HIV+ hospital inpatients found the Fujifilm SILVAMP TB LAM test to have a 28.1% higher sensitivity than the Alere Determine TB LAM Ag and the Fujifilm SILVAMP TB LAM could diagnose 65% of patients with active TB within 24 h. A meta-analysis with 1,595 inpatients and outpatients showed 70.7% sensitivity and 90.9% specificity for TB diagnosis in people living with HIV for Fujifilm SILVAMP TB LAM. The test showed a high positive predictive value (95.2%) in HIV-negative outpatients and has the potential to improve rapid, urine-based TB diagnosis in general populations at the point-of-care. Large prospective studies are on the way. Interferon-γ release assays Interferon-γ (interferon-gamma) release assays (IGRAs) are relatively new tests for tuberculosis. IGRAs are based