Tuberculous pleural effusion is a common cause of patient admission in Mulago hospital especially among patients infected with HIV.Histology and pleural tissue culture for MTB, the gold standard involves an invasive procedure which requires specific skills and is time consuming. We tested the diagnostic accuracy of Cepheid's MTB-specific Gene Xpert, a PCR based real time test using pleural fluid with the aim of trying to get a quicker, more user friendly, accurate and less invasive method in the diagnosis of pleural TB in our setting.This test has been proven to improve diagnose of pulmonary TB with accuracy and in less than 2 hours. Varying levels of accuracy of this test in the diagnosis of pleural TB diagnosis have been reported from small pilot studies. A South African study by Sven et al 2011 however demonstrated a sensitivity of 25% and specificity of 100% on 20 samples of confirmed pleural TB patients. Objectives: To determine the accuracy of TB-specific Gene Xpert test in the diagnosis of TB pleura among adult patients with suspected tuberculous pleural effusions attending Mulago Hospital Pulmonology Service over the study period.