Comparative impacts and cost-effectiveness of tuberculosis systematic screening strategies in prisons in Brazil, Colombia, and Peru: A mathematical modeling study
Rattachement africain : us, br, bo, ni, pe, co, do. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
BACKGROUND: Incarceration is a leading driver of tuberculosis in Latin America. Systematic screening in prisons may reduce tuberculosis burden, but optimal strategies and cost-effectiveness remain uncertain. We examined the population-wide health impacts and cost-effectiveness of systematic screening in prisons in Brazil, Colombia, and Peru, comparing different timepoints, frequencies, and screening algorithms. METHODS AND FINDINGS: Using dynamic transmission models calibrated to Brazil, Colombia, and Peru, we simulated annual or biannual (twice-yearly) prison-wide screening, alone or combined with entry and exit screening from 2026 to 2035. We evaluated four algorithms: (1) symptom screening, (2) chest X-ray with computer-aided detection (CXR-CAD), (3) symptoms and CXR-CAD (follow-up testing if either is positive), and (4) GeneXpert Ultra (Xpert) with pooled sputum. Individuals screening positive then received individual Xpert. We projected impacts on within-prison and population-level tuberculosis incidence in 2035, along with discounted costs (2023 US dollars) and disability-adjusted life years (DALYs). Model projections showed that combined entry, exit, and biannual screening with CXR-CAD was highly impactful and cost-effective across countries, reducing tuberculosis incidence by 61%-87% in prisons and 18%-28% population-wide. Compared to only biannual CXR-CAD (the next best strategy), the incremental cost per DALY averted of adding entry and exit screening was $2,984 (Brazil), $2,925 (Colombia), and $645 (Peru). Adding symptom screening to CXR-CAD marginally increased benefit and was only cost-effective in Peru's higher-incidence prisons. Biannual screening alone remained cost-effective at prison incidence levels well below national averages, as well as at far lower willingness-to-pay thresholds. In settings without CXR-CAD, pooled Xpert was an impactful, cost-effective alternative. Key limitations include the model's simplified representation of tuberculosis disease states and lack of stratification by age, gender/sex, HIV, or drug resistance. CONCLUSIONS: These modeling results support immediate national-level adoption of prison-wide tuberculosis screening twice-yearly and at entry and exit, using CXR-CAD or pooled Xpert.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Comparative impacts and cost-effectiveness of tuberculosis systematic screening strategies in prisons in Brazil, Colombia, and Peru: A mathematical modeling study
- Date Crossref
- 04/06/2026
- Éditeur
- Public Library of Science (PLoS)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Yale University SEICHE Center for Health and Justice pays non établi dans la noticeUniversité ou école supérieure
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Stanford University Department of Medicine pays non établi dans la noticeUniversité ou école supérieure
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Universidade Federal de Mato Grosso do Sul pays non établi dans la noticeUniversité ou école supérieure
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Ministério da Saúde pays non établi dans la noticeOrganisme public
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World Health Organization Regional Office for the Americas pays non établi dans la noticeOrganisme public
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Ministerio de Salud pays non établi dans la noticeOrganisme public
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Ministry of Health National Tuberculosis Program pays non établi dans la noticeOrganisme public
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Ministry of Health and Social Protection pays non établi dans la noticeOrganisme public
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Universidad Autónoma de Santo Domingo pays non établi dans la noticeUniversité ou école supérieure
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Escuela Nacional Superior de Ballet pays non établi dans la noticeUniversité ou école supérieure
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University of Cincinnati Medical Center pays non établi dans la noticeÉtablissement de santé
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Federal University of Mato Grosso do Sul pays non établi dans la noticeUniversité ou école supérieure
SEICHE Center for Health and Justice — Yale University, Department of Medicine — Stanford University et Universidade Federal de Mato Grosso do Sul, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.