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- Title
Pooling Sputum Samples for Efficient Mass Tuberculosis Screening in Prisons.
- Authors
Santos, Paulo César Pereira dos; Santos, Andrea da Silva; Oliveira, Roberto Dias de; Silva, Bruna Oliveira da; Soares, Thiego Ramon; Martinez, Leonardo; Verma, Renu; Andrews, Jason R; Croda, Julio
- Abstract
Background Although systematic tuberculosis screening in high-risk groups is recommended by the World Health Organization (WHO), implementation in prisons has been limited due to resource constraints. Whether Xpert Ultra sputum pooling could be a sensitive and efficient approach to mass screening in prisons is unknown. Methods In total, 1280 sputum samples were collected from incarcerated individuals in Brazil during mass screening and tested using Xpert G4. We selected samples for mixing in pools of 4, 8, 12, and 16, which were then tested using Ultra. In each pool, a single positive sample of differing Xpert mycobacterial loads was used. Additionally, 10 pools of 16 negative samples each were analyzed as controls. We then simulated tuberculosis screening at prevalences of 0.5–5% and calculated the cost per tuberculosis case detected at different sputum pooling sizes. Results The sensitivity and specificity of sputum pooling were high (sensitivity: 94%; 95% confidence interval [CI]: 88–98; specificity: 100%, 95% CI: 84–100). Sensitivity was greater in pools in which the positive sample had a high mycobacterial load compared to those that were very low (100% vs 88%). In settings with a higher tuberculosis prevalence, pools of 4 and 8 were more efficient than larger pool sizes. Larger pools decreased the costs by 87% at low prevalences, whereas smaller pools led to greater cost savings at higher prevalence at higher prevalences (57%). Conclusions Sputum pooling using Ultra was a sensitive strategy for tuberculosis screening. This approach was more efficient than individual testing across a broad range of simulated tuberculosis prevalence settings and could enable active case finding to be scaled while containing costs.
- Subjects
BRAZIL; TUBERCULOSIS epidemiology; TUBERCULOSIS diagnosis; CORRECTIONAL institutions; CONFIDENCE intervals; SPUTUM; MEDICAL screening; COST control; COST analysis; MYCOBACTERIUM tuberculosis; DESCRIPTIVE statistics; DISEASE prevalence; COLLECTION &; preservation of biological specimens; SENSITIVITY &; specificity (Statistics); LONGITUDINAL method
- Publication
Clinical Infectious Diseases, 2022, Vol 74, Issue 12, p2115
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciab847