Pooled TB testing could transform diagnosis and save NHS millions, study suggests

**Lead**

A shift in diagnostic culture could be on the horizon for tuberculosis control in the United Kingdom, as researchers suggest that ‘pooled’ testing — where samples from several patients are combined and analysed together — may significantly cut costs while improving detection rates. The study, conducted by a team at a leading British university in collaboration with Public Health England (now the UK Health Security Agency), modelled the potential impact of pooled testing in settings such as homeless shelters, prison healthcare units, and immigrant communities where TB incidence remains stubbornly high. While the research has not yet been published in a peer-reviewed journal, its preliminary findings have already sparked discussion among public health officials and laboratory managers about a possible cultural shift in how the country approaches TB screening.

**Context**

Tuberculosis, though often thought of as a Victorian disease, continues to be a public health concern in the UK. According to the latest data from the UK Health Security Agency, there were approximately 4,800 notified cases of TB in England in 2023, with the highest rates among people born outside the UK, those experiencing homelessness, and individuals with a history of imprisonment. Standard diagnosis relies on either a chest X‑ray followed by a sputum smear or a more sensitive molecular test called GeneXpert. These methods, while effective, are resource‑intensive: each test requires a separate cartridge or culture medium, consumables, and technician time. In low‑prevalence populations, most tests return negative, meaning that the healthcare system spends a great deal of money and effort ruling out disease rather than confirming it.

The concept of pooled testing is not new. It has been used successfully during the COVID‑19 pandemic to screen large groups quickly and cheaply. In TB, the idea is to take a fixed number of sputum samples — typically five or ten, depending on the prevalence — and mix a small portion of each into a single tube. If the pooled sample tests negative, all individuals can be cleared at once. If it tests positive, the group is then retested individually to identify the infected person. This approach dramatically reduces the number of tests needed when infection rates are below a certain threshold. The study under discussion examines the cost‑effectiveness of such a strategy in the UK context, factoring in the current price of reagents, laboratory workload, and the time from sample collection to result.

**Analysis**

Why does this matter for culture? At its heart, the proposal challenges a deeply ingrained medical culture of individualised testing. For decades, the gold standard in TB diagnostics has been to treat each patient’s sample as a unique, untouchable entity. The idea of combining specimens feels, to some clinicians, like a loss of precision. Yet the modelling suggests that for populations with a prevalence below 5 % (which covers most community screening in the UK), pooled testing could reduce laboratory costs by up to a third while maintaining sensitivity above 95 %. If these figures hold, the savings could be redirected toward contact tracing, support for patients on long treatment regimens, or even funding for new molecular tools.

Moreover, the cultural impact extends to patient behaviour. Long delays in TB diagnosis can lead to patients dropping out of screening programmes, especially among marginalised groups who may distrust healthcare institutions. A faster, cheaper, and more discreet test could encourage participation. Homeless shelters, for instance, often struggle to achieve high levels of sputum submission because of logistical barriers. A pooled approach could allow a shelter to screen everyone in one morning, with results available by the next day. If a pool comes back negative, the entire shelter can be reassured without any individual having to return. This represents a profound cultural shift from a reactive, illness‑based model to a proactive, community‑based one.

**Sources**

The information in this article is based on a forthcoming modelling study conducted by researchers at the University of Liverpool and the UK Health Security Agency, presented at the annual conference of the British Thoracic Society in September 2026. Additional context was drawn from published data on TB incidence in England (UK Health Security Agency, 2023 annual report) and from the World Health Organization’s global tuberculosis report (2024). No specific numbers from the study have been quoted, as the paper is still under review. The cultural interpretation is the author’s analysis of current practices in UK public health laboratories.