Screening for latent tuberculosis infection: USPSTF finalizes recommendation

USPSTF releases latent tuberculosis infection screening recommendation.
USPSTF releases latent tuberculosis infection screening recommendation.

The US Preventive Services Task Force (USPSTF) recommends screening for latent tuberculosis infection (LTBI) in all persons with an increased risk of infection, according to its recommendation statement published in JAMA.

The task force gave a B grade recommendation for asymptomatic adults at increased risk for tuberculosis infection. Populations who are at increased risk include individuals who are former residents of countries with increased tuberculosis presence and individuals who have lived in homeless shelters or correctional facilities.

The task force's systematic review included evidence about screening for LTBI in asymptomatic adults older than 18 years of age in primary care settings. It identified 67 good or fair-quality studies that examined the accuracy and reliability of screening tests of LTBI.

The authors of the recommendation noted the results of the International Union Against Tuberculosis trial, which studied the effectiveness of early tuberculosis treatment. The trial was conducted in 7 European countries and included individuals with fibrotic pulmonary lesions, but not active tuberculosis. After 5 years, the results showed that the relative risk of progression to active tuberculosis was 0.35 for treatment with isoniazid compared with placebo.

The researchers found no studies that directly reported on the harms of LTBI screening, although some studies noted that the stigma associated with screening and a diagnostic workup and treatment of false-positive results as potential harms.

 “Overall, the USPSTF found adequate evidence that accurate screening tests for LTBI are available, treatment of LTBI provides a moderate health benefit in preventing progression to active disease, and the harms of screening and treatment are small,” the authors of the recommendation noted.

The USPSTF notes in its recommendation that the Mantoux tuberculin skin test and interferon-gamma release assays are both moderately sensitive and highly specific tests that can detect LTBI. The task force found no evidence regarding the optimal frequency of screening for LTBI.

Further research is required to evaluate risk assessment tools and to develop methods to identify candidates for LTBI screening. Future studies should also focus on the frequency of LTBI screening in different subpopulations.

In response to public comment from a draft version of its recommendation, “The USPSTF clarified that given regional variations in the local populations considered at risk for tuberculosis, clinicians may consult their local or state public health agency for additional details on specific populations at risk in their community. Furthermore, the USPSTF clarified that although persons with diabetes and pregnant women are not addressed separately in this recommendation statement, they are also not excluded from the recommendation.”

Reference

  1. US Preventive Services Task Force. Screening for latent tuberculosis infection in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;316(9):962-969. doi:10.1001/jama.2016.11046.
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