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Examining Test Cutoffs to Optimize Diagnosis of Latent Tuberculosis Infection in People Born Outside the United States.

Publication ,  Journal Article
Zavala, S; Winglee, K; Ho, CS; Pettit, AC; Ahmed, A; Katz, DJ; Belknap, RW; Stout, JE
Published in: Ann Am Thorac Soc
September 2023

Rationale: Detection of latent tuberculosis infection (LTBI) in persons born in high tuberculosis (TB) incidence countries living in low TB incidence countries is key to TB elimination in low-incidence countries. Optimizing LTBI tests is critical to targeting treatment. Objectives: To compare the sensitivity and specificity of tuberculin skin test (TST) and two interferon-γ release assays at different cutoffs and of a single test versus dual testing. Methods: We examined a subset (N = 14,167) of a prospective cohort of people in the United States tested for LTBI. We included non-U.S.-born, human immunodeficiency virus-seronegative people ages 5 years and older with valid TST, QuantiFERON-TB Gold-in-Tube (QFT), and T-SPOT.TB (TSPOT) results. The sensitivity/specificity of different test cutoffs and test combinations, obtained from a Bayesian latent class model, were used to construct receiver operating characteristic (ROC) curves and assess the area under the curve (AUC) for each test. The sensitivity/specificity of dual testing was calculated. Results: The AUC of the TST ROC curve was 0.81 (95% credible interval (CrI), 0.78-0.86), with sensitivity/specificity at cutoffs of 5, 10, and 15 mm of 86.5%/61.6%, 81.7%/71.3%, and 55.6%/88.0%, respectively. The AUC of the QFT ROC curve was 0.89 (95% CrI, 0.86-0.93), with sensitivity/specificity at cutoffs of 0.35, 0.7, and 1.0 IU/mL of 77.7%/98.3%, 66.9%/99.1%, and 61.5%/99.4%. The AUC of the TSPOT ROC curve was 0.92 (95% CrI, 0.88-0.96) with sensitivity/specificity for five, six, seven, and eight spots of 79.2%/96.7%, 76.8%/97.7%, 74.0%/98.6%, and 71.8%/99.5%. Sensitivity/specificity of TST-QFT, TST-TSPOT, and QFT-TSPOT at standard cutoffs were 73.1%/99.4%, 64.8%/99.8%, and 65.3%/100%. Conclusion: Interferon-γ release assays have a better predictive ability than TST in people at high risk of LTBI.

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Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

September 2023

Volume

20

Issue

9

Start / End Page

1258 / 1266

Location

United States

Related Subject Headings

  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Zavala, S., Winglee, K., Ho, C. S., Pettit, A. C., Ahmed, A., Katz, D. J., … Stout, J. E. (2023). Examining Test Cutoffs to Optimize Diagnosis of Latent Tuberculosis Infection in People Born Outside the United States. Ann Am Thorac Soc, 20(9), 1258–1266. https://doi.org/10.1513/AnnalsATS.202212-1005OC
Zavala, Sofia, Kathryn Winglee, Christine S. Ho, April C. Pettit, Amina Ahmed, Dolly J. Katz, Robert W. Belknap, and Jason E. Stout. “Examining Test Cutoffs to Optimize Diagnosis of Latent Tuberculosis Infection in People Born Outside the United States.Ann Am Thorac Soc 20, no. 9 (September 2023): 1258–66. https://doi.org/10.1513/AnnalsATS.202212-1005OC.
Zavala S, Winglee K, Ho CS, Pettit AC, Ahmed A, Katz DJ, et al. Examining Test Cutoffs to Optimize Diagnosis of Latent Tuberculosis Infection in People Born Outside the United States. Ann Am Thorac Soc. 2023 Sep;20(9):1258–66.
Zavala, Sofia, et al. “Examining Test Cutoffs to Optimize Diagnosis of Latent Tuberculosis Infection in People Born Outside the United States.Ann Am Thorac Soc, vol. 20, no. 9, Sept. 2023, pp. 1258–66. Pubmed, doi:10.1513/AnnalsATS.202212-1005OC.
Zavala S, Winglee K, Ho CS, Pettit AC, Ahmed A, Katz DJ, Belknap RW, Stout JE. Examining Test Cutoffs to Optimize Diagnosis of Latent Tuberculosis Infection in People Born Outside the United States. Ann Am Thorac Soc. 2023 Sep;20(9):1258–1266.

Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

September 2023

Volume

20

Issue

9

Start / End Page

1258 / 1266

Location

United States

Related Subject Headings

  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology