Evaluating Latent Tuberculosis Infection Test Performance Using Latent Class Analysis in a TB and HIV Endemic Setting.

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Tytuł:: Evaluating Latent Tuberculosis Infection Test Performance Using Latent Class Analysis in a TB and HIV Endemic Setting.
Autorzy:: Adams S; School of Public Health and Family Medicine, Division of Occupational Medicine, University of Cape Town, Observatory 7925, South Africa.
Ehrlich R; School of Public Health and Family Medicine, Division of Occupational Medicine, University of Cape Town, Observatory 7925, South Africa.
Baatjies R; Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town 8000, South Africa.
Dendukuri N; Division of Clinical Epidemiology, McGill University Health Centre-Research Institute, Montreal, QC H4A 3J1, Canada.
Wang Z; Division of Clinical Epidemiology, McGill University Health Centre-Research Institute, Montreal, QC H4A 3J1, Canada.
Dheda K; Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Observatory, Cape Town 7925, South Africa. .; Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK. .
Źródło:: International journal of environmental research and public health [Int J Environ Res Public Health] 2019 Aug 14; Vol. 16 (16). Date of Electronic Publication: 2019 Aug 14.
Typ publikacji:: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Original Publication: Basel : MDPI, c2004-
MeSH Terms:: Latent Class Analysis*
HIV Infections/*diagnosis
Health Personnel/*statistics & numerical data
Interferon-gamma Release Tests/*methods
Latent Tuberculosis/*diagnosis
Tuberculin Test/*methods
Adult ; Aged ; Aged, 80 and over ; Female ; HIV Infections/epidemiology ; Humans ; Latent Tuberculosis/epidemiology ; Male ; Middle Aged ; Prevalence ; Sensitivity and Specificity ; South Africa/epidemiology
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Grant Information:: IU2RTW007370-01A1 United States NH NIH HHS; R24 TW007988-03 United States NH NIH HHS
Contributed Indexing:: Keywords: health care worker; latent class analysis; latent tuberculosis infection
Entry Date(s):: Date Created: 20190817 Date Completed: 20200107 Latest Revision: 20200309
Update Code:: 20240105
PubMed Central ID:: PMC6720895
DOI:: 10.3390/ijerph16162912
PMID:: 31416206
: Czasopismo naukowe

Background: Given the lack of a gold standard for latent tuberculosis infection (LTBI) and paucity of performance data from endemic settings, we compared test performance of the tuberculin skin test (TST) and two interferon-gamma-release assays (IGRAs) among health-care workers (HCWs) using latent class analysis. The study was conducted in Cape Town, South Africa, a tuberculosis and human immunodeficiency virus (HIV) endemic setting Methods: 505 HCWs were screened for LTBI using TST, QuantiFERON-gold-in-tube (QFT-GIT) and T-SPOT.TB. A latent class model utilizing prior information on test characteristics was used to estimate test performance.
Results: LTBI prevalence (95% credible interval) was 81% (71-88%). TST (10 mm cut-point) had highest sensitivity (93% (90-96%)) but lowest specificity (57%, (43-71%)). QFT-GIT sensitivity was 80% (74-91%) and specificity 96% (94-98%), and for TSPOT.TB, 74% (67-84%) and 96% (89-99%) respectively. Positive predictive values were high for IGRAs (90%) and TST (99%). All tests displayed low negative predictive values (range 47-66%). A composite rule using both TST and QFT-GIT greatly improved negative predictive value to 90% (range 80-97%).
Conclusion: In an endemic setting a positive TST or IGRA was highly predictive of LTBI, while a combination of TST and IGRA had high rule-out value. These data inform the utility of LTBI-related immunodiagnostic tests in TB and HIV endemic settings.

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