Review and cost-effective and rapid tuberculosis screening: Implementing the sputum pooling method in Indonesia

Background: Indonesia continues to face significant challenges in meeting its tuberculosis (TB) case detection targets, partly due to the underutilization of diagnostic resources like Rapid Molecular Tests (RMTs). Innovative, costeffective strategies are urgently needed to scale up screening efforts.

Objectives: This study aims to review the diagnostic accuracy, cost-effectiveness, and implementation considerations of the pooling sputum strategy to assess its potential for enhancing TB screening in Indonesia.

Materials and methods: This study was conducted using publicly available data from the Indonesian Ministry of Health and findings from existing literature. The projected impact was analyzed by implementing a 4-sample pooling sputum method for RMT (Xpert MTB/RIF Ultra) compared to the current individual testing strategy.

Results: The analysis projects that the pooling sputum strategy could increase RMT screening capacity fourfold. The national average monthly tests per RMT unit could rise from 120 to 480 individuals screened. Consequently, the projected time required to screen 100,000 individuals per province could decrease from an average of 5.5 months to 1.4 months. The strategy offers potential cost savings averaging 36.71% (±14.97%). A review of diagnostic data from previous studies shows high accuracy (sensitivity 97.35%; specificity 99.25%).

Conclusion: The pooling sputum method presents a viable and powerful strategy to significantly enhance the efficiency of TB screening in Indonesia. This approach can substantially increase RMT utilization, accelerate case detection, and reduce costs, thereby helping Indonesia progress towards its 2030 TB elimination targets. A pilot study is recommended to validate these findings within the Indonesian healthcare context.