Background Although systematic tuberculosis screening in high-risk groups is recommended by 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. Methods 1,280 sputum samples were collected from inmates 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. Results The sensitivity and specificity of sputum pooling were high (sensitivity: 94%; 95% 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 fitted greater at higher prevalences (57%). Conclusions Sputum 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.

No abstract

No abstract

Objective: to evaluate the infrastructure of basic health units, as the adaptation to the standards recommended by the Ministry of Health. Methods: descriptive study with a quantitative approach, carried in 18 basic health units. For data collection, we used a checklist built based on Ministerial Decree 2,226/09. Data analysis was performed using the Statistical Package for Social Sciences and a scoring scale (0-10) was used for the classification of health facilities. Results: 16.6% of the analyzed units received the average score of 3.5; 16.6% received 3.0; 5.5%, 2.5; 16.6% received grade 2.0; 11.1%, 1.5; 11.1%, 1.0; and 22.2% received 0.5 and, therefore, all units had inadequate physical structure. Conclusion: the city does not offer the public a service that addresses the ideals standards in its structure in most of the inspected units. Descriptors: Health Services Evaluation; Health Infrastructure; Primary Health Care.Objetivo: avaliar a infraestrutura de unidades básicas de saúde, quanto à adequação às normas preconizadas pelo Ministério da Saúde. Métodos: estudo descritivo, com abordagem quantitativa, realizado em 18 unidades básicas de saúde. Para coleta de dados, utilizou-se checklist construído com base na Portaria Ministerial 2.226/09. A análise dos dados foi realizada por meio do Statistical Package for the Social Sciences e empregou-se escala de pontuação (0-10) para classificação das unidades de saúde. Resultados: das unidades analisadas, 16,6% ficaram com a nota igual a 3,5; 16,6% com 3,0; 5,5% com 2,5; 16,6% com nota 2,0; 11,1% com 1,5; 11,1% com 1,0; e 22,2% ficaram com 0,5, estando, portanto, todas com estrutura física inadequada. Conclusão: o município não oferece ao público um serviço que contemple os padrões ideais em sua estrutura, na maioria das unidades inspecionadas.Objetivo: evaluar la infraestructura de unidades básicas de salud, cuanto a la adaptación a las normas recomendadas por el Ministerio de la Salud. Métodos: estudio descriptivo, con abordaje cuantitativa, realizado en 18 unidades básicas de salud. Para recolección de datos, se utilizó lista construida con base en el Decreto Ministerial 2.226/09. Se realizó el análisis de datos utilizando el Statistical Package for the Social Sciences y empleó a escala de puntuación (0-10) para clasificación de los unidades de salud. Resultados: de las unidades analizadas, 16,6% estaban con puntuación media de 3,5; 16,6% con 3,0; 5,5% con 2,5; 16,6% con nota 2,0; 11,1% con 1,5; 11,1% con 1,0; y 22,2% alcanzaron 0,5, por lo tanto, todas con estructura física inadecuada. Conclusión: la ciudad no ofrece al público servicio que contemple las normas ideales en su estructura, en la mayoría de las unidades inspeccionadas.

No abstract