ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2022
Pooling Sputum Samples for Efficient Mass Tuberculosis Screening in Prisons.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 24 citations in OpenAlex.
- Community-based "X-ray+Xpert® MTB/RIF ultra pooling test" case-finding strategy among high-risk groups in rural areas: a prospective application study.Emerging microbes & infections · 2026Article
- Comparative impacts and cost-effectiveness of tuberculosis systematic screening strategies in prisons in Brazil, Colombia, and Peru: A mathematical modeling study.PLoS medicine · 2026Article
- Factors associated with tuberculosis symptom reporting among persons deprived of liberty in Brazil during active case finding: a cross-sectional study.BMJ public health · 2026Article
- Evaluation of an ultra-portable X-ray system with automated interpretation for tuberculosis active case finding in carceral settings: a diagnostic test accuracy study.BMC infectious diseases · 2025Article
- Comparative impacts and cost-effectiveness of tuberculosis active case-finding strategies in prisons in Brazil, Colombia, and Peru: a mathematical modeling study.medRxiv : the preprint server for health sciences · 2025Article
- Evaluation of an ultra-portable X-ray system with automated interpretation for tuberculosis active case finding in carceral settings: a diagnostic test accuracy study.Research square · 2025Article
- Sputum pooling for rapid and cost-effective active case-finding for TB in prisons.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2025Article
- Reagent efficiency and analytical sensitivity optimization for a reliable SARS-CoV-2 pool-based testing strategy.Heliyon · 2025Article
- Role of tuberculosis symptoms in transmission risk to cell contacts in prisons.BMJ public health · 2025Article
- Serial Mass Screening for Tuberculosis Among Incarcerated Persons in Brazil.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Pooling sputum samples for the Xpert MTB/RIF assay: a practical screening strategy for highly infectious tuberculosis cases.BMC infectious diseases · 2024Article
- Expanding molecular diagnostic coverage for tuberculosis by combining computer-aided chest radiography and sputum specimen pooling: a modeling study from four high-burden countries.BMC global and public health · 2024Article
- The impact of sputum quality on Xpert positivity in active case-finding for TB.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2024Article
- Evaluation of chest X-ray with automated interpretation algorithms for mass tuberculosis screening in prisons: a cross-sectional study.Lancet regional health. Americas · 2023Article
- Epidemiology and control strategies for tuberculosis in countries with the largest prison populations.Revista da Sociedade Brasileira de Medicina Tropical · 2022Review
Corrections and comments
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Authors and funding
9 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundAlthough 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.
methodsIn 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.
resultsThe 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%).
conclusionsSputum 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.
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