Screening for tuberculosis in prisons: efficacy of a breath-based diagnostic approach in a high prevalence setting.
Authors
Affiliations (15)
Affiliations (15)
- Department of Respiratory Diseases, TB Expert Center Dekkerswald, Radboud University Medical Center, Nijmegen, The Netherlands; National Institute of Respiratory and Environmental Diseases (INERAM), Prof. Dr. Juan Max Boettner, Asunción, Paraguay. Electronic address: [email protected].
- Department of Respiratory Diseases, TB Expert Center Dekkerswald, Radboud University Medical Center, Nijmegen, The Netherlands; Facultad de Ingeniería, National University of Asunción (UNA), San Lorenzo, Paraguay. Electronic address: [email protected].
- Department of surveillance, National Tuberculosis Program, Ministry of Health, Asunción, Paraguay.
- National Institute of Respiratory and Environmental Diseases (INERAM), Prof. Dr. Juan Max Boettner, Asunción, Paraguay.
- Facultad de Ingeniería, National University of Asunción (UNA), San Lorenzo, Paraguay.
- Department of prison health, Ministry of Justice, Asunción, Paraguay.
- National Reference Laboratory, department of mycobacteria, Ministry of Health, Asunción, Paraguay.
- Department of Genetics and Microbiology, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain; Mycobacterial Infections Study Group (GEIM) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain; Biomedical Research Centre in Infectious Diseases Network (CIBERINFEC), Carlos III Health Institute, Madrid, Spain.
- Department of Tuberculosis Control, Municipal Public Health Service, Amsterdam, The Netherlands.
- Instituto de Saúde Pública da Universidade do Porto, EPIUnit ITR, University of Porto, Porto, Portugal.
- Instituto de Saúde Pública da Universidade do Porto, EPIUnit ITR, University of Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
- Department of Respiratory Diseases, TB Expert Center Dekkerswald, Radboud University Medical Center, Nijmegen, The Netherlands.
- Instituto de Saúde Pública da Universidade do Porto, EPIUnit ITR, University of Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal; Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA-Porto), Porto, Portugal.
- Mycobacterial Infections Study Group (GEIM) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain; Biomedical Research Centre in Infectious Diseases Network (CIBERINFEC), Carlos III Health Institute, Madrid, Spain; VInternational Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, PROSICS Barcelona, all d'Hebron University Hospital, Autonomous University of Barcelona,Barcelona, Spain.
- KNCV Tuberculosis Foundation, The Hague, The Netherlands. Electronic address: [email protected].
Abstract
Tuberculosis (TB) remains a major health threat in prisons, where overcrowding and limited access to care facilitate transmission. We evaluated the diagnostic accuracy and feasibility of the AeoNose for TB screening in Paraguayan prisons. In this cross-sectional diagnostic study, people deprived of liberty and prison staff underwent symptom screening, chest X-ray with CAD4TB (v6), and AeoNose breath sampling. Individuals with presumptive TB underwent GeneXpert and mycobacterial culture. Breath signals were analysed using a convolutional neural network. Two subsets were evaluated: all participants with valid samples and the same population excluding prior TB. Five-fold cross-validation was applied. Of 3,752 individuals screened, 2,993 had valid samples. TB prevalence was 6.7%. In subset 1 (188 TB cases) and subset 2 (142 TB cases), mean AUC was 0.634 (SD 0.040) and 0.624 (0.054). Sensitivity and specificity were 0.670 (95% CI 0.592-0.737) and 0.537 (0.518-0.555), and 0.711 (0.630-0.793) and 0.505 (0.491-0.519). Under real-world prison conditions, AeoNose did not meet WHO criteria for a TB triage test. However, large-scale breath-based screening using portable devices was feasible, supporting further development of non-invasive screening approaches.