Xpert MTB/RIF test demonstrates efficacy for detecting TB in prisons
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Testing all inmates for tuberculosis using sputum Xpert MTB/RIF was a sensitive, efficient and cost-effective approach for mass screening in tuberculosis-endemic prisons, according to a recent study.
“Prisons frequently have a very high burden of tuberculosis,” Andrea da Silva Santos, of the faculty of health sciences at the Federal University of Grande Dourados in Brazil, and colleagues wrote. “Despite the high rates of tuberculosis in prisoners and the potential importance of this population in the overall epidemic, there are few studies which have assessed the efficiency and costs of different approaches for screening for tuberculosis among incarcerated populations.”
De Silva Santos and colleagues screened 5,387 inmates from three Brazilian prisons for TB between 2017 and 2018 using symptom assessment, chest radiography, sputum testing by Xpert MTB/RIF 4th generation and cultures to assess the percent of total cases found, efficiency for each algorithm and unit costing to estimate the costs of each screening or diagnostic test per case detected for each algorithm.
Of the inmates screened, 214 (3.9%) were diagnosed with TB. A single Xpert MTB/RIF sputum test identified 74% of all TB cases at a cost of $249. In addition, conducting the Xpert MTB/RIF screening tests only on inmates with symptoms had a similar cost per case diagnosed ($255), but missed as many cases (73 compared with 54) as screening all inmates.
“Our results suggest that mass tuberculosis screening in high-burden prisons, conducted by sputum Xpert MTB/RIF testing of all inmates or those with symptoms, is an effective approach to case detection at a modest cost per case detected,” the authors concluded. “Active case finding by sputum testing with Xpert MTB/RIF should be scaled in Brazilian prisons and other high-burden countries to address tuberculosis in incarcerated populations.”
In an accompanying editorial, Marc Woodman, MD, and Louis Grandjean, MD, PhD, of University College London’s Institute of Child Health, agreed that the study “argues correctly” for the application of the Xpert MTB/RIF test in similar, high-burden settings worldwide.
“If the WHO End TB targets are to be achieved, then well-informed, well-funded and widespread scaling-up of tuberculosis control in prisons is a good place to start,” Woodman and Grandjean wrote. – by Caitlyn Stulpin
Disclosures: Da Silva Santos, Grandjean and Woodman report no relevant financial disclosures.
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Da Silva Santos A, et al. Clin Infect Dis. 2020;doi:10.1093/cid/ciaa135.
Woodman M, et al. Clin Infect Dis. 2020;doi:10.1093/cid/ciaa139.
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