{"doi":"10.3390/ijerph16162912","title":"Evaluating Latent Tuberculosis Infection Test Performance Using Latent Class Analysis in a TB and HIV Endemic Setting","abstract":"<jats:p>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.</jats:p>","journal":"International Journal of Environmental Research and Public Health","year":2019,"id":634177,"datarank":0.48283137373023016,"base_score":3.2188758248682006,"endowment":3.2188758248682006,"self_citation_contribution":0.48283137373023016,"citation_network_contribution":0.0,"self_endowment_contribution":0.48283137373023016,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":24,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":252312,"name":"Rodney Ehrlich","orcid":"0000-0001-5736-9237","position":1,"is_corresponding":false},{"id":1076142,"name":"Roslynn Baatjies","orcid":"0000-0002-3772-071X","position":2,"is_corresponding":false},{"id":1431269,"name":"Nandini Dendukuri","orcid":"0000-0002-2330-0976","position":3,"is_corresponding":false},{"id":1644641,"name":"Zhuoyu Wang","orcid":"0000-0002-8940-8226","position":4,"is_corresponding":false},{"id":528806,"name":"Keertan Dheda","orcid":"0000-0001-7709-5341","position":5,"is_corresponding":false},{"id":780756,"name":"Shahieda Adams","orcid":"0000-0002-3630-1855","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Evaluating Latent Tuberculosis Infection Test Performance Using Latent Class Analysis in a TB and HIV Endemic Setting","abstract":"<jats:p>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.</jats:p>","is_dataset_classified":null,"base_score":3.2188758248682006,"endowment":3.2188758248682006,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"31416206","pmcid":"PMC6720895","openalex_id":"https://openalex.org/W2968300393","authors":[],"funders":[{"funder_name":"South African Medical Research Council","grant_id":"RFA-EMU-02-2017","title":null},{"funder_name":"European and Developing Countries Clinical Trials Partnership","grant_id":"TMA-2015SF-1043 & TMA- 1051-TESAII","title":null},{"funder_name":"European and Developing Countries Clinical Trials Partnership","grant_id":"EDCTP TB NEAT: IP_09_32040_009","title":null},{"funder_name":"National Institutes of Health","grant_id":"IU2RTW007370-01A1","title":null},{"funder_name":"National Institutes of Health","grant_id":"R24 TW007988-03","title":null},{"funder_name":"European & Developing Countries Clinical Trials Partnership (EDCTP)","grant_id":"TMA-2015SF-1043 &amp; TMA- 1051-TESAII","title":null},{"funder_name":"National Institutes of Health","grant_id":"5R24TW007988-04","title":"Fogarty International Clinical Research Scholars Support Center @ Vanderbilt-AAMC"},{"funder_name":"National Institutes of Health","grant_id":"3U2RTW007370-05S1","title":"South Africa Tuberculosis AIDS Training (SATBAT)"}],"total_grants":8,"fwci":0.6779,"citation_percentile":0.68254875,"influential_citations":0,"citation_trend":[{"year":2020,"count":1},{"year":2021,"count":3},{"year":2022,"count":1},{"year":2023,"count":6},{"year":2024,"count":7},{"year":2025,"count":2},{"year":2026,"count":4}],"oa_status":"gold","license":"cc-by-nc-sa","oa_locations":[{"url":"https://www.mdpi.com/1660-4601/16/16/2912/pdf?version=1565777053","host_type":"journal"},{"url":"https://www.mdpi.com/1660-4601/16/16/2912/pdf?version=1565777053","host_type":"publisher"},{"url":"https://www.mdpi.com/1660-4601/16/16/2912/pdf","host_type":"publisher"},{"url":"https://doi.org/10.3390/ijerph16162912","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/31416206","host_type":"repository"},{"url":"https://researchonline.lshtm.ac.uk/view/creators/ipmbkdhe.html>;","host_type":"repository"},{"url":"https://www.mdpi.com/1660-4601/16/16/2912/","host_type":"repository"},{"url":"https://doaj.org/article/991c50fa5325488885d695690bcb55b6","host_type":"repository"},{"url":"http://dx.doi.org/10.3390/ijerph16162912","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/6720895","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC6720895","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC6720895?pdf=render","host_type":"Europe_PMC"},{"url":"https://dx.doi.org/10.3390/ijerph16162912","host_type":""}],"fields_of_study":["Tuberculosis Research and Epidemiology","Infectious Diseases and Tuberculosis","Diagnosis and treatment of tuberculosis","03 medical and health sciences","0302 clinical medicine","Adult","Aged","Aged, 80 and over","Female","HIV Infections","Health Personnel","Humans","Interferon-gamma Release Tests","Latent Class Analysis","Latent Tuberculosis","Male","Middle Aged","Prevalence","Sensitivity and Specificity","South Africa","Tuberculin Test"],"mesh_terms":["Latent Class Analysis","Adult","Aged","Aged, 80 and over","Female","Health Personnel","Humans","Male","Middle Aged","Sensitivity and Specificity","South Africa","Tuberculin Test","HIV Infections","Prevalence","Latent Tuberculosis","Interferon-gamma Release Tests"],"keywords":["Latent class model","Latent tuberculosis","Tuberculosis","Human immunodeficiency virus (HIV)","Medicine","Test (biology)","Virology","Immunology","Mycobacterium tuberculosis","Biology","Statistics","Mathematics","Pathology","Latent Class Analysis","Latent Tuberculosis Infection","Health Care Worker","Adult","Aged, 80 and over","Male","Tuberculin Test","Health Personnel","HIV Infections","Middle Aged","Sensitivity and Specificity","Article","South Africa","Prevalence","Humans","Female","Interferon-gamma Release Tests","Aged"],"sdg_mappings":[{"sdg_number":3,"sdg_label":"3. 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