In Tanzania sputum culture for tuberculosis (TB) is resource intensive and available only at zonal facilities. In this study overnight pooled sputum collection technique was compared with standard spot morning collection among pulmonary TB suspects at Kibong'oto National TB Hospital in Tanzania. A spot sputum specimen performed at enrollment, an overnight pooled sputum, and single morning specimen were collected from 50 subjects and analyzed for quality, quantity, and time to detection in Bactec MGIT system. Forty-six (92%) subjects' overnight pooled specimens had a volume ≥5？mls compared to 37 (37%) for the combination of spot and single morning specimens ( ). Median time to detection was 96 hours (IQR 87–131) for the overnight pooled specimens compared to 110.5 hours (IQR is 137 right 137–180) for the combination of both spot and single morning specimens ( ). In our setting of limited TB culture capacity, we recommend a single pooled sputum to maximize yield and speed time to diagnosis. 1. Background Tuberculosis (TB) and HIV are among the global leaders in infectious disease mortality [1]. Sub-Saharan Africa has one of the highest burdens of TB and HIV coinfection [2]. Prompt diagnosis of TB is critical to improve outcome, but diagnosis of TB is challenging in HIV-infected patients and especially in resource-limited settings [3]. HIV-infected patients have a higher rate of extrapulmonary TB, atypical chest radiographs and fewer pulmonary cavities [4–6]. As a consequence, HIV patients may be more likely to have a negative or paucibacillary sputum smear microscopy [7]. Subjects with paucibacillary specimens may be prone to being delayed in clinical diagnosis, either because acid-fast bacilli are not observed by microscopy or time to detection Mycobacterium tuberculosis (MTB) culture is prolonged [8]. Both poor quality and low quantity of sputum have a significant impact on TB detection rate [9, 10]. In settings reliant on smear microscopy as the only means of TB diagnosis, this may impact negatively the time to initiation of TB treatment. Ideal specimens should contain 5？mL or more of sputum without saliva. A previous study found that the quality and quantity of sputum were improved by pooling three versus a single “spot” collection [11]. However, collection on multiple days may unnecessarily burden health facilities and may be prone to contamination. In contrast, a single overnight pooled technique whereby a patient is given a sealable container in which to collect all expectorated sputum over the course of the night has been used in TB treatment
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