USO DE LA PRUEBA MOLECULAR RÁPIDA DE TUBERCULOSIS EN PERSONAS PRIVADAS DE LIBERTAD: REVISIÓN DE ALCANCE

Naves, Elisangela Franciscon; Andrade, Rubia Laine de Paula; Faria, Mariana Gaspar Botelho Funari de; Magnabosco, Gabriela Tavares; Bonfim, Rafaele Oliveira; Ferreira, Melisane Regina Lima; Bollela, Valdes Roberto; Monroe, Aline Aparecida

doi:10.1590/1980-265X-TCE-2023-0288en

person Elisangela Franciscon Naves

Study design · Data collection · Data analysis and interpretation · Discussion of results · Writing and/or critical review of content · Review and final approval of the final version

schoolUniversidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Pós-Graduação Enfermagem em Saúde Pública. Ribeirão Preto, SP, Brasil.

0000-0001-5138-4428

person Rubia Laine de Paula Andrade

Study design · Data collection · Data analysis and interpretation · Discussion of results · Writing and/or critical review of content · Review and final approval of the final version

schoolUniversidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Materno-Infantil e Saúde Pública. Ribeirão Preto, SP, Brasil.

0000-0001-5843-1733

person Mariana Gaspar Botelho Funari de Faria

Data analysis and interpretation · Discussion of results · Writing and/or critical review of content · Review and final approval of the final version

schoolUniversidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Pós-Graduação Enfermagem em Saúde Pública. Ribeirão Preto, SP, Brasil.

0000-0002-5544-910X

person Gabriela Tavares Magnabosco

Discussion of results · Writing and/or critical review of content · Review and final approval of the final version

schoolUniversidade Estadual de Maringá, Departamento de Enfermagem, Programa de Pós-Graduação em Enfermagem. Maringá, PR, Brasil.

0000-0003-3318-6748

person Rafaele Oliveira Bonfim

Discussion of results · Writing and/or critical review of content · Review and final approval of the final version

schoolUniversidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Pós-Graduação Enfermagem em Saúde Pública. Ribeirão Preto, SP, Brasil.

0000-0001-8157-2323

person Melisane Regina Lima Ferreira

Discussion of results · Writing and/or critical review of content · Review and final approval of the final version

schoolUniversidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Pós-Graduação Enfermagem em Saúde Pública. Ribeirão Preto, SP, Brasil.

0000-0003-1694-5124

person Valdes Roberto Bollela

Discussion of results · Writing and/or critical review of content · Review and final approval of the final version

schoolUniversidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica e Divisão de Moléstias Infecciosas. Ribeirão Preto, SP, Brasil.

0000-0002-8221-4701

person Aline Aparecida Monroe

Study design · Data analysis and interpretation · Discussion of results · Writing and/or critical review of content · Review and final approval of the final version

schoolUniversidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Pós-Graduação Enfermagem em Saúde Pública. Ribeirão Preto, SP, Brasil.

0000-0003-4073-2735

personCORRESPONDING AUTHOR Rubia Laine de Paula Andrade.
emailrubia@eerp.usp.br

CONFLICT OF INTEREST

There is no conflict of interest.

EDITORS

Associated Editors: Gisele Cristina Manfrini, Ana Izabel Jatobá de Souza. Editor-in-chief: Elisiane Lorenzini

Information sources	Search strategies
Scopus	TITLE-ABS-KEY (tuberculosis OR tb) AND TITLE-ABS-KEY (prison OR prisons OR "penal institution" OR "penal institutions" OR "social adaptation centers" OR "penal centers" OR jail OR jails OR "people deprived of liberty" OR "person deprived of liberty" OR "persons deprived of liberty" OR "population deprived of liberty" OR inmate OR inmates OR prisoner OR prisoners OR detainee OR detainees OR arrested) AND TITLE-ABS-KEY ("rapid molecular test" OR "rapid molecular diagnostic test" OR "rapid molecular diagnostic testing" OR xpert OR "rapid molecular assay" OR "rapid molecular assays" OR "rapid molecular diagnostic assay" OR "rapid molecular diagnostic assays" OR "rapid diagnostic test" OR "rapid diagnostic testing" OR "rapid diagnostic assay" OR "rapid diagnostic assays" OR "rapid molecular detection test" OR "rapid molecular detection testing" OR "rapid molecular detection assay" OR "rapid molecular detection assays" OR "rapid molecular detection method" OR "rapid molecular detection methods" OR "sputum molecular testing assay" OR "sputum molecular testing assays" OR "rapid molecular screening" OR "rapid molecular detection of tuberculosis" OR "rapid molecular diagnostic for tuberculosis" OR "rapid molecular diagnosis of tuberculosis" OR "rapid molecular detection of mycobacterium tuberculosis" OR "rapid molecular diagnostic for mycobacterium tuberculosis" OR "rapid molecular diagnosis of mycobacterium tuberculosis")
Web of Science	((TS=(tuberculosis OR tb)) AND TS=(prison OR prisons OR "penal institution" OR "penal institutions" OR "social adaptation centers" OR "penal centers" OR jail OR jails OR "people deprived of liberty" OR "person deprived of liberty" OR "persons deprived of liberty" OR "population deprived of liberty" OR inmate OR inmates OR prisoner OR prisoners OR detainee OR detainees OR arrested)) AND TS=("rapid molecular test" OR "rapid molecular diagnostic test" OR "rapid molecular diagnostic testing" OR xpert OR "rapid molecular assay" OR "rapid molecular assays" OR "rapid molecular diagnostic assay" OR "rapid molecular diagnostic assays" OR "rapid diagnostic test" OR "rapid diagnostic testing" OR "rapid diagnostic assay" OR "rapid diagnostic assays" OR "rapid molecular detection test" OR "rapid molecular detection testing" OR "rapid molecular detection assay" OR "rapid molecular detection assays" OR "rapid molecular detection method" OR "rapid molecular detection methods" OR "sputum molecular testing assay" OR "sputum molecular testing assays" OR "rapid molecular screening" OR "rapid molecular detection of tuberculosis" OR "rapid molecular diagnostic for tuberculosis" OR "rapid molecular diagnosis of tuberculosis" OR "rapid molecular detection of mycobacterium tuberculosis" OR "rapid molecular diagnostic for mycobacterium tuberculosis" OR "rapid molecular diagnosis of mycobacterium tuberculosis")
Pubmed / MEDLINE	((tuberculosis OR tb) AND (prison OR prisons OR "penal institution" OR "penal institutions" OR "social adaptation centers" OR "penal centers" OR jail OR jails OR "people deprived of liberty" OR "person deprived of liberty" OR "persons deprived of liberty" OR "population deprived of liberty" OR inmate OR inmates OR prisoner OR prisoners OR detainee OR detainees OR arrested)) AND ("rapid molecular test" OR "rapid molecular diagnostic test" OR "rapid molecular diagnostic testing" OR xpert OR "rapid molecular assay" OR "rapid molecular assays" OR "rapid molecular diagnostic assay" OR "rapid molecular diagnostic assays" OR "rapid diagnostic test" OR "rapid diagnostic testing" OR "rapid diagnostic assay" OR "rapid diagnostic assays" OR "rapid molecular detection test" OR "rapid molecular detection testing" OR "rapid molecular detection assay" OR "rapid molecular detection assays" OR "rapid molecular detection method" OR "rapid molecular detection methods" OR "sputum molecular testing assay" OR "sputum molecular testing assays" OR "rapid molecular screening" OR "rapid molecular detection of tuberculosis" OR "rapid molecular diagnostic for tuberculosis" OR "rapid molecular diagnosis of tuberculosis" OR "rapid molecular detection of mycobacterium tuberculosis" OR "rapid molecular diagnostic for mycobacterium tuberculosis" OR "rapid molecular diagnosis of mycobacterium tuberculosis")
LILACS	(Tuberculose OR tuberculosis OR tb) AND (prisão OR prisões OR "instituição penal" OR "instituições penais" OR "centro de readaptação social" OR "centros de readaptação social" OR "centros penais" OR cárcere OR cárceres OR penitenciária OR penitenciárias OR presídio OR presídios OR "unidade prisional" OR "unidades prisionais" OR "pessoa privada de liberdade" OR "pessoas privadas de liberdade" OR "população privada de liberdade" OR detento OR detentos OR encarcerado OR encarcerada OR encarcerados OR encarceradas OR prisioneiro OR prisioneiros OR prisioneira OR prisioneiras OR preso OR presos OR sentenciado OR sentenciados OR apenado OR apenados OR prison OR prisons OR "penal institution" OR "penal institutions" OR "social adaptation centers" OR "penal centers" OR jail OR jails OR "people deprived of liberty" OR "person deprived of liberty" OR "persons deprived of liberty" OR "population deprived of liberty" OR inmate OR inmates OR prisoner OR prisoners OR detainee OR detainees OR arrested OR prisión OR prisiones OR "institución penal" OR "instituciónes penales" OR "centro de readaptación social" OR "centros de readaptación social" OR "centro penal" OR "centros penales" OR cárcel OR cárceles OR penitenciaría OR penitenciarías OR "persona privada de libertad" OR "personas privadas de libertad" OR "población privada de libertad" OR detenido OR detenidos OR encarcelado OR encarcelados OR encarcelada OR encarceladas OR prisionero OR prisioneros OR prisionera OR prisioneras OR preso OR presos OR arrestado OR sentenciado OR sentenciados OR condenado OR condenados) AND ( "teste rápido molecular" OR "teste molecular rápido" OR "rapid molecular test" OR "rapid molecular diagnostic test" OR "rapid molecular diagnostic testing" OR xpert OR genexpert OR "rapid molecular assay" OR "rapid molecular assays" OR "rapid molecular diagnostic assay" OR "rapid molecular diagnostic assays" OR "rapid diagnostic test" OR "rapid diagnostic testing" OR "rapid diagnostic assay" OR "rapid diagnostic assays" OR "rapid molecular detection test" OR "rapid molecular detection testing" OR "rapid molecular detection assay" OR "rapid molecular detection assays" OR "rapid molecular detection method" OR "rapid molecular detection methods" OR "sputum molecular testing assay" OR "sputum molecular testing assays" OR "rapid molecular screening" OR "rapid molecular detection of tuberculosis" OR "rapid molecular diagnostic for tuberculosis" OR "rapid molecular diagnosis of tuberculosis" OR "rapid molecular detection of mycobacterium tuberculosis" OR "rapid molecular diagnostic for mycobacterium tuberculosis" OR "rapid molecular diagnosis of mycobacterium tuberculosis" OR "prueba rápida molecular" OR "pruebas rápidas moleculares" OR "prueba molecular rápida" OR "pruebas moleculares rápidas" OR "diagnóstico molecular rápido")
Academic Search Premier/ CINAHL	( tuberculosis OR tb ) AND ( prison OR prisons OR "penal institution" OR "penal institutions" OR "social adaptation centers" OR "penal centers" OR jail OR jails OR "people deprived of liberty" OR "person deprived of liberty" OR "persons deprived of liberty" OR "population deprived of liberty" OR inmate OR inmates OR prisoner OR prisoners OR detainee OR detainees OR arrested ) AND ( "rapid molecular test" OR "rapid molecular diagnostic test" OR "rapid molecular diagnostic testing" OR xpert OR "rapid molecular assay" OR "rapid molecular assays" OR "rapid molecular diagnostic assay" OR "rapid molecular diagnostic assays" OR "rapid diagnostic test" OR "rapid diagnostic testing" OR "rapid diagnostic assay" OR "rapid diagnostic assays" OR "rapid molecular detection test" OR "rapid molecular detection testing" OR "rapid molecular detection assay" OR "rapid molecular detection assays" OR "rapid molecular detection method" OR "rapid molecular detection methods" OR "sputum molecular testing assay" OR "sputum molecular testing assays" OR "rapid molecular screening" OR "rapid molecular detection of tuberculosis" OR "rapid molecular diagnostic for tuberculosis" OR "rapid molecular diagnosis of tuberculosis" OR "rapid molecular detection of mycobacterium tuberculosis" OR "rapid molecular diagnostic for mycobacterium tuberculosis" OR "rapid molecular diagnosis of mycobacterium tuberculosis" )
Embase	('tuberculosis'/exp OR tuberculosis OR 'tb'/exp OR tb) AND ('prison'/exp OR prison OR 'prisons'/exp OR prisons OR 'penal institution'/exp OR 'penal institution' OR 'penal institutions' OR 'social adaptation centers' OR 'penal centers' OR 'jail'/exp OR jail OR 'jails'/exp OR jails OR 'people deprived of liberty' OR 'person deprived of liberty' OR 'persons deprived of liberty' OR 'population deprived of liberty' OR 'inmate'/exp OR inmate OR 'inmates'/exp OR inmates OR 'prisoner'/exp OR prisoner OR 'prisoners'/exp OR prisoners OR detainee OR detainees OR arrested( AND ('rapid molecular test' OR 'rapid molecular diagnostic test' OR 'rapid molecular diagnostic testing' OR 'xpert'/exp OR xpert OR 'rapid molecular assay' OR 'rapid molecular assays' OR 'rapid molecular diagnostic assay' OR 'rapid molecular diagnostic assays' OR 'rapid diagnostic test'/exp OR 'rapid diagnostic test' OR 'rapid diagnostic testing' OR 'rapid diagnostic assay' OR 'rapid diagnostic assays' OR 'rapid molecular detection test' OR 'rapid molecular detection testing' OR 'rapid molecular detection assay' OR 'rapid molecular detection assays' OR 'rapid molecular detection method' OR 'rapid molecular detection methods' OR 'sputum molecular testing assay' OR 'sputum molecular testing assays' OR 'rapid molecular screening' OR 'rapid molecular detection of tuberculosis' OR 'rapid molecular diagnostic for tuberculosis' OR 'rapid molecular diagnosis of tuberculosis' OR 'rapid molecular detection of mycobacterium tuberculosis' OR 'rapid molecular diagnostic for mycobacterium tuberculosis' OR 'rapid molecular diagnosis of mycobacterium tuberculosis')
Biblioteca Digital Brasileira de Teses e Dissertações	"(Todos os campos: Tuberculose OR tuberculosis OR tb E Todos os campos: prisão OR prisões OR "instituição penal" OR "instituições penais" OR "centro de readaptação social" OR "centros de readaptação social" OR "centros penais" OR cárcere OR cárceres OR penitenciária OR penitenciárias OR presídio OR presídios OR "unidade prisional" OR "unidades prisionais" OR "pessoa privada de liberdade" OR "pessoas privadas de liberdade" OR "população privada de liberdade" OR detento OR detentos OR encarcerado OR encarcerada OR encarcerados OR encarceradas OR prisioneiro OR prisioneiros OR prisioneira OR prisioneiras OR preso OR presos OR sentenciado OR sentenciados OR apenado OR apenados OR prison OR prisons OR "penal institution" OR "penal institutions" OR "social adaptation centers" OR "penal centers" OR jail OR jails OR "people deprived of liberty" OR "person deprived of liberty" OR "persons deprived of liberty" OR "population deprived of liberty" OR inmate OR inmates OR prisoner OR prisoners OR detainee OR detainees OR arrested OR prisión OR prisiones OR "institución penal" OR "instituciónes penales" OR "centro de readaptación social" OR "centros de readaptación social" OR "centro penal" OR "centros penales" OR cárcel OR cárceles OR penitenciaría OR penitenciarías OR "persona privada de libertad" OR "personas privadas de libertad" OR "población privada de libertad" OR detenido OR detenidos OR encarcelado OR encarcelados OR encarcelada OR encarceladas OR prisionero OR prisioneros OR prisionera OR prisioneras OR preso OR presos OR arrestado OR sentenciado OR sentenciados OR condenado OR condenados E Todos os campos:"teste rápido molecular" OR "teste molecular rápido" OR "rapid molecular test" OR "rapid molecular diagnostic test" OR "rapid molecular diagnostic testing" OR xpert OR genexpert OR "rapid molecular assay" OR "rapid molecular assays" OR "rapid molecular diagnostic assay" OR "rapid molecular diagnostic assays" OR "rapid diagnostic test" OR "rapid diagnostic testing" OR "rapid diagnostic assay" OR "rapid diagnostic assays" OR "rapid molecular detection test" OR "rapid molecular detection testing" OR "rapid molecular detection assay" OR "rapid molecular detection assays" OR "rapid molecular detection method" OR "rapid molecular detection methods" OR "sputum molecular testing assay" OR "sputum molecular testing assays" OR "rapid molecular screening" OR "rapid molecular detection of tuberculosis" OR "rapid molecular diagnostic for tuberculosis" OR "rapid molecular diagnosis of tuberculosis" OR "rapid molecular detection of mycobacterium tuberculosis" OR "rapid molecular diagnostic for mycobacterium tuberculosis" OR "rapid molecular diagnosis of mycobacterium tuberculosis" OR "prueba rápida molecular" OR "pruebas rápidas moleculares" OR "prueba molecular rápida" OR "pruebas moleculares rápidas" OR "diagnóstico molecular rápido")"
Google Scholar (six searches were carried out)	tuberculose prisões "teste rápido molecular" tuberculose prisioneiros "teste rápido molecular" tuberculosis prisons "rapid molecular test" tuberculosis prisoners "rapid molecular test" tuberculosis prisiones "prueba rapida molecular" tuberculosis prisioneros "rapid molecular test"

Authors, year of publication/ Journal/ Country	Type of publication	Study design	Objective	Study population (n)	Main results
^{Winetsky et al., 2012}²² / PLOS Medicine / Russia and Western Europe	Article	Cost-effectiveness study	Develop models to simulate simultaneous TB* and MDR-TB^† epidemics in prisons in order to assess the relative effectiveness and cost-effectiveness of alternative strategies for TB* screening and diagnosis available to prison health administrators.	It used public data without identification, but did not mention the size of the population studied.	The use of RMT-TB^‡ as an annual primary screening tool among the prison population more effectively reduced the prevalence of TB* (from 2.78% to 2.31%) and the prevalence of MDR-TB^† (from 0.74% to 0.63%). The addition of RMT-TB^‡ to the currently used strategy of annual mass radiography screening was cost-effective over 10 years compared with mass radiography screening alone, but produced only a modest reduction in the prevalence of MDR-TB^† (from 0. 74% to 0.69%) and had minimal effect on TB* prevalence (from 2.78% to 2.74%).
^{Al-Darraji et al., 2013}²³ / PLOS ONE / Malaysia	Article	Cross-sectional study	To estimate the diagnostic accuracy of a single RMT-TB^‡ assay and assess the correlates of active TB* among PDL^§ living with HIV^\|\| in a Malaysian prison.	125 PDL^§ with HIV^\|\|	The sensitivity of RMT-TB^‡ for pulmonary cases was 53.3%, while the specificity and positive predictive value was 100%. The negative predictive value of the test was 94%. RMT-TB^‡ diagnosed eight of the 15 cases confirmed by sputum culture, while sputum smear microscopy diagnosed only one case.
^{Gurbanova et al., 2017}²⁴ / European Respiratory Journal / Azerbaijan	Resumo publicado em anais de evento	Not reported	To evaluate the impact of systematic screening with chest radiography and RMT-TB^‡ on the incidence of TB* in prisons with a high burden of the disease	2,315 PDL^§ with TB*	Systematic screening and screening at the entrance of the PDL^§ to the prison unit with RMT-TB^‡ enabled greater identification of bacilliferous cases (adjusted odds ratio 1.49 and 2.0, respectively) when compared to mass screening by sputum smear microscopy. The notification rate decreased significantly after the introduction of systematic screening.
^{Morishita et al., 2017}²⁵ / PLOS ONE / The Phillippines	Article	Retrospective review	Describe TB* diagnostic yield and treatment outcomes for different target populations. Examine predictors of TB* and the contribution of improved diagnostic tools to overall case detection.	25,103 individuals participated in the study, of which 6,133 were PDL^§	2,130 PDL^§ were subjected to both tests: RMT-TB^‡ and sputum smear microscopy, with 358 (16.8%) positive to RMT-TB^‡ and 217 (10.2%) positive to sputum smear microscopy. RMT-TB^‡ also diagnosed 29 cases of resistance to rifampicin.
^{Magalhães et al., 2018}²⁶ / Revista Brasileira de Análises Clínicas / Brazil	Article	Prospective cross-sectional study	To evaluate an easy-to-perform and low-cost procedure to increase the performance of conventional direct smear microscopy in the diagnosis of pulmonary TB* in PDL^§.	436 sputum samples	When comparing the performance of the evaluated methods in relation to culture, the sensitivity of conventional direct sputum smear microscopy was 70%, that of processed sputum sputum smear microscopy was 87% and that of RMT-TB^‡ was 89%. The specificity of these tests was 99%, 99% and 97%, respectively. The positive predictive value was 98%, 93% and 84%, respectively, while the negative predictive value was 94%, 98% and 98%. The reference test was RMT-TB, the sensitivity of direct sputum smear microscopy was 65%, of processed sputum smear microscopy was 84% and culture of 84%.
^{Merid et al., 2018}²⁷ / The International Journal of Tuberculosis and Lung Disease / Ethiopia	Article	Cross-sectional study	Determine pulmonary TB* burden using active case finding among PDL^§.	2,068 PDL^§, of which 372 had a cough and were tested with microscopy and RMT-TB	Carrying out RMT-TB^‡ enabled identifying 31 (8%) cases of pulmonary TB*, while microscopy identified eight (2%) cases. RMT-TB^‡ also enabled identifying a case of resistance to rifampicin.
^{Monteiro et al., 2018}²⁸ / Colloq Vitae / Brazil	Article	Retrospective cohort	Analyze the importance of automated culture (“gold standard”), the performance of RMT-TB^‡ and the distribution of the TB* quantity in five prison units.	4,509 PDL^§	RMT-TB^‡ presented a specificity of 99.0%, sensitivity of 72.7% and agreement of 97.0% in results when compared to culture (Reference Test).
^{Buangoen; Ingviya, 2020}²⁹ / Journal of the Medical Association of Thailand / Thailand	Article	Cross-sectional study	To estimate the prevalence of pulmonary TB* in four prisons in Songkhla Province and evaluate the factors affecting the results of the RMT-TB^‡ trial	10,626 PDL^§ initially tested with X-ray, and if image suggestive of pulmonary TB* they were submitted to microscopy or RMT-TB^‡	The RMT-TB^‡ did not help diagnose TB* in prisons in this study.
^{Evrevin et al., 2021}³⁰ / Journal of Infection / France	Article	Diagnostic accuracy	Assess the feasibility and interest of implementing RMT-TB^‡ in prison hospitals to reduce delays in diagnosis.	76 PDL^§ admitted to a custody hospital	The overall sensitivity, specificity, positive and negative predictive values of RMT-TB^‡ were respectively: 92.3%, 100%, 100% and 98.7% in raw sputum. The efficiency of RMT-TB^‡ was superior to sputum smear microscopy and confirmed by a 97% agreement with culture findings. The delay in microbiological diagnosis was reduced from 18 to 13 days for inmates with negative smear microscopy. RMT-TB^‡ results helped accelerate the suspension of prisoner isolation.
^{Fajer et al., 2021}³¹ / medRxiv preprint / Brazil	Preprint Article	Retrospective cross-sectional study	Analyze the SINAN ^¶ registry to quantify the use of RMT-TB^‡ and chest radiography in PDL^§ in Brazil and identify critical gaps in the use of recommended diagnostic methods.	258,014 new TB* cases reported between 2015 and 2018	Diagnosis with RMT-TB^‡ varied from 4.7% and 4.9% in Pará and Mato Grosso, to 64.5% and 72.4% in Goiás and Amapá, respectively. Among 26 municipalities in Brazil with at least five thousand individuals and five cases of TB* diagnosed between 2015-2018, seven reported that less than 36.2% (national average) of incarcerated patients were diagnosed with RMT-TB^‡.
^{Santos et al., 2021}³² / Clinical Infectious Diseases / Brazil	Article	Prospective study	To analyze the yield, efficiency and costs associated with four TB* screening algorithms in PDL^§.	5,387 PDL^§	Using a single RMT-TB^‡ sputum test for all resulted in the detection of 74% of cases at a lower cost ($249 per case detected). Using a single RMT-TB^‡ sputum test only for those reporting TB symptoms had a similar cost ($255) but resulted in a lower yield (65%). Two strategies using chest radiography with computer-assisted detection associated with RMT-TB^‡ had higher costs ($331 and $384, respectively, per case detected), with the fourth strategy having a slightly higher yield than the first (78% vs 74%).
^{Freitas et al., 2022}³³ / Cogitare Enfermagem / Brasil	Article	Descriptive study	To compare the performance of diagnostic tests and monitoring of TB* between the general population and populations in situations of social vulnerability in the city of Belo Horizonte (MG).	249 PDL^§	A reduction in the average time to start treatment in PDL was observed with the introduction of RMT-TB^‡ (the average time decreased from 16.57 days to 0.95 days)
^{Santos et al., 2022}³⁴ / Clinical Infectious Diseases / Brasil	Article	Prospective study	To evaluate the sensitivity and specificity of the pooled sputum test with RMT-TB^‡ compared to the individual test; Evaluate how the size of the sputum cluster affects screening efficiency in scenarios with different TB prevalence; Estimate costs for screening using pooled sputum testing with RMT-TB^‡.	1,280 sputum samples from PDL^§	The study grouped four, eight, 12 and 16 sputum samples. Sample pooling sensitivity and specificity were high (sensitivity: 94%; 95% confidence interval [CI]: 88-98; specificity: 100%, 95%CI: 84-100). Sensitivity was higher in clusters where the positive sample had a high mycobacterial load compared to low loads (100% vs 88%). In places with higher TB* prevalence, clusters of four and eight samples were more efficient than larger clusters. Larger pools decreased costs by 87% in low prevalence sites, while smaller sample pools led to greater cost savings in sites with higher TB* prevalence (57%).

[TFN1] Legend: *TB - Tuberculosis; ^†MDR-TB - Multidrug-resistant Tuberculosis; ^‡RMT-TB - Rapid Molecular Test for Tuberculosis; ^§PDL - People Deprived of Liberty; ^||HIV - Human Immunodeficiency Virus; ^¶ SINAN - Notifiable Diseases Information System.