PCR Screening of Prisoners’ Sputum Could Reduce TB in Former Soviet Union, Study Says

A new medical study concludes that PCR screening of sputum from prison inmates in the former Soviet Union is the most cost-effective method of reducing the spread of tuberculosis in Russia and other Eastern European countries. Posting on the PLOS Medicine site, a research team led by Daniel Winetsky of the Stanford University School of Medicine evaluated eight strategies for TB screening and diagnosis. Alone or in combination, these included self-referral, symptom screening, and mass miniature radiography (MMR). The researchers determined that “adding sputum PCR to the currently used strategy of annual MMR screening alone, but produced only a modest reduction.”
The researchers note that high rates of multidrug-resistant TB (MDR-TB) in the prisons of the former Soviet Union are thought to cause TB epidemics among the general population. Cost-effective detection in prisons could reduce long-term treatment costs and slow transmission of MDR-TB, the authors write. Adding PCR screening of sputum to the annual MMR screening for detection of MDR-TB slightly reduced the prevalence of MDR-TB and saved approximately $2000 over 10 years per model prison of 1000 inmates, the researchers conclude.
In terms of methodology, the researchers used a “dynamic transmission model” for determining the spread of TB among prison inmates through different infection stages. The model was used to estimate the costs, quality-adjusted life years saved, TB prevalence, and MDR-TB prevalence for eight screening strategies over 10 years. Grants from Äids Fonds/the Netherlands, the U.S. Department of State, and NIH helped to fund the study.
---John Conroy