Tuberculosis (TB) remains a significant public health challenge in many African communities, where underreporting and underdiagnosis are prevalent due to barriers in accessing care and inadequate diagnostic tools. This is particularly concerning in hard-to-reach areas with a high burden of TB/HIV co-infection, where missed or delayed diagnoses exacerbate disease transmission, increase mortality and lead to severe economic and health consequences. To address these challenges, it is crucial to evaluate innovative, cost-effective, community-based screening strategies that can improve early detection and linkage to care.

We conduct a prospective, community-based, diagnostic, pragmatic trial in communities of the Butha Buthe District in Lesotho and the Greater Edendale area of Msunduzi Municipality, KwaZulu-Natal in South Africa to compare two strategies for population-based TB screening: computer-aided detection (CAD) technology alone (CAD4TBv7 approach) versus CAD combined with point-of-care C reactive protein (CRP) testing (CAD4TBv7-CRP approach). Following a chest X-ray, CAD produces an abnormality score, which indicates the likelihood of TB. Score thresholds informing the screening logic for both approaches were determined based on the WHO’s target product profile for a TB screening test. CAD scores above a threshold prespecified for the CAD4TBv7 approach indicate confirmatory testing for TB (Xpert MTB/RIF Ultra). For the CAD4TBv7-CRP approach, a CAD score within a predefined window requires the conduct of the second screening test, CRP, while a score above the respective upper threshold is followed by Xpert MTB/RIF Ultra. A CRP result above the selected cut-off also requires a confirmatory TB test. Participants with CAD scores below the (lower) threshold and those with CRP levels below the cut-off are considered screen-negative. The trial aims to compare the yield of detected TB cases and cost-effectiveness between two screening approaches by applying a paired screen-positive design. 20 000 adult participants will be enrolled and will receive a posterior anterior digital chest X-ray which is analysed by CAD software.

The protocol was approved by National Health Research Ethics Committee in Lesotho (NH-REC, ID52-2022), the Human Sciences Research Council Research Ethics Committee (HSRC REC, REC 2/23/09/20) and the Provincial Health Research Committee of the Department of Health of KwaZulu-Natal (KZ_202209_022) in South Africa and from the Swiss Ethics Committee Northwest and Central Switzerland (EKNZ, AO_2022–00044). This manuscript is based on protocol V.4.0, 19 January 2024. Trial findings will be disseminated through peer-reviewed publications, conference presentations and through communication offices of the consortium partners and the project’s website (https://tbtriage.com/).

ClinicalTrials.gov (NCT05526885), South African National Clinical Trials Register (SANCTR; DOH-27-092022-8096).

This longitudinal study aimed to document shifts in specialty preferences, career pathways and intended practice locations among medical students following the implementation of structured career initiatives during the 2023–2024 academic year.

A longitudinal observational survey study.

A private, not-for-profit institution, VinUniversity in Hanoi, Vietnam during the 2023–2024 academic year.

All year 2, year 3 and year 4 medical students (n=144 eligible), of whom 105 (73%) completed both baseline and follow-up surveys.

Structured career counselling initiatives introduced at the start of the academic year, including academic mentoring, clinical mentoring, hands-on clinical exposure in year 4 and multiple career counselling activities.

The primary outcome was change in specialty preference over time, measured by students’ self-reported first-choice specialty at baseline and follow-up. Secondary outcomes included shifts in factors influencing career decisions (eg, personal interest, income and family expectations), intended practice location (domestic or international) and preferred career pathways (residency, Specialist Level I, master’s degree or direct workforce entry).

Personal interest remained the strongest influence on specialty choice from baseline to follow-up (mean scores 4.27 vs 4.36 on a 5-point scale). A notable decrease occurred in the importance of income (3.82 to 3.22; p

Noticeable shifts in specialty preferences and career pathways were observed after a series of career initiatives were implemented. Although these trends coincided with the new programmes, further qualitative research is needed to elucidate how and why these career initiatives may have influenced decision-making. Informed by these findings, medical educators can refine interventions to support students’ evolving preferences and ultimately strengthen healthcare workforce distribution.