Mass TB screening with point-of-care test is cost-effective, Brazil prison study shows

Suppose you have a large group of people, confined together, considered likely to pose a threat to people outside their walls, but without the ready means to determine if they pose a threat to each other? If the space wasn't built to contain the spread of an airborne infectious diseases, a public health disaster could be among the unintended consequences of that arrangement.

The potential for that outcome was most noticeably demonstrated in recent weeks on the Diamond Princess cruise ship, which, with passengers potentially exposed to Covid-19 quarantined aboard, quickly became home to more people with the disease than any other place in the world outside of China. But it is also a scenario that continues, year in and year out, to feed the spread of the deadliest infectious disease on earth, in prisons around the world, where rates of tuberculosis are about 23 times greater than those in the world outside the walls.

A study reported this week in Clinical Infectious Diseases shows how reliably detecting disease, through mass screening with an accurate point of care diagnostic tool, could save both money and lives.

Examining the outcomes of mass screenings for tuberculosis at three prisons in Brazil researchers found use of the the Xpert MTB/RIF, as fast accurate molecular test for TB that also detects drug resistance, as the most cost effective, at $249 for each case detected, compared to $255 for symptom screening followed by culture testing, and chest X-rays, the most costly and least efficient. The results support the use of Xpert MTB/RIF for use in prisons where tuberculosis is endemic.

The report on the study is accompanied in the same issue by a commentary: Detecting Tuberculosis in Prisons -- Switching off the Disease at its Source.