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Tuberculin skin test and Interferon-gamma release assay agreement, and associated factors with latent tuberculosis infection, in medical and nursing students in Bandung, Indonesia

Background No gold standard diagnostic test exists for latent tuberculosis infection (LTBI). The intra-dermal tuberculin skin test (TST) has known limitations and Interferon-gamma release assays (IGRA) have been developed as an alternative. We aimed to assess agreement between IGRA and TST, and risk...

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Published in:	PLoS ONE 2024, Vol.19 (3), p.e0299874
Main Authors:	Apriani, Lika, McAllister, Susan, Sharples, Katrina, Aini, Isni Nurul, Nurhasanah, Hanifah, Ratnaningsih, Dwi Febni, Indrati, Agnes Rengga, Ruslami, Rovina, Alisjahbana, Bachti, van Crevel, Reinout, Hill, Philip C
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Language:	English
Subjects:	Care and treatment Diagnosis Evaluation Health aspects Interferon gamma Tuberculin test Tuberculosis
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creator	Apriani, Lika McAllister, Susan Sharples, Katrina Aini, Isni Nurul Nurhasanah, Hanifah Ratnaningsih, Dwi Febni Indrati, Agnes Rengga Ruslami, Rovina Alisjahbana, Bachti van Crevel, Reinout Hill, Philip C
description	Background No gold standard diagnostic test exists for latent tuberculosis infection (LTBI). The intra-dermal tuberculin skin test (TST) has known limitations and Interferon-gamma release assays (IGRA) have been developed as an alternative. We aimed to assess agreement between IGRA and TST, and risk factors for test positivity, in Indonesian healthcare students. Methods Medical and nursing students starting their clinical training were screened using IGRA and TST. Agreement between the two tests was measured using Cohen's Kappa coefficient. Logistic regression was used to identify factors associated with test positivity. Results Of 266 students, 43 (16.2%) were IGRA positive and 85 (31.9%) TST positive. Agreement between the two tests was 74.7% (kappa 0.33, 95% CI 0.21-0.45, P
doi_str_mv	10.1371/journal.pone.0299874
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The intra-dermal tuberculin skin test (TST) has known limitations and Interferon-gamma release assays (IGRA) have been developed as an alternative. We aimed to assess agreement between IGRA and TST, and risk factors for test positivity, in Indonesian healthcare students. Methods Medical and nursing students starting their clinical training were screened using IGRA and TST. Agreement between the two tests was measured using Cohen's Kappa coefficient. Logistic regression was used to identify factors associated with test positivity. Results Of 266 students, 43 (16.2%) were IGRA positive and 85 (31.9%) TST positive. Agreement between the two tests was 74.7% (kappa 0.33, 95% CI 0.21-0.45, P<0.0001). Students who had direct contact with family or friends with TB were less likely to be test positive using IGRA (AOR 0.18, 95% CI 0.05-0.64) and using TST (AOR 0.51, 95% CI 0.26-0.99). Conclusion Test positivity for LTBI was lower when measured by IGRA than by TST, with poor agreement between the two tests. Known close TB contact was unexpectedly negatively associated with positivity by either test. Longitudinal studies may be required to help determine the best test for LTBI in healthcare students in Indonesia.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0299874</identifier><language>eng</language><publisher>Public Library of Science</publisher><subject>Care and treatment ; Diagnosis ; Evaluation ; Health aspects ; Interferon gamma ; Tuberculin test ; Tuberculosis</subject><ispartof>PLoS ONE, 2024, Vol.19 (3), p.e0299874</ispartof><rights>COPYRIGHT 2024 Public Library of Science</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>776,780,4476,27902</link.rule.ids></links><search><creatorcontrib>Apriani, Lika</creatorcontrib><creatorcontrib>McAllister, Susan</creatorcontrib><creatorcontrib>Sharples, Katrina</creatorcontrib><creatorcontrib>Aini, Isni Nurul</creatorcontrib><creatorcontrib>Nurhasanah, Hanifah</creatorcontrib><creatorcontrib>Ratnaningsih, Dwi Febni</creatorcontrib><creatorcontrib>Indrati, Agnes Rengga</creatorcontrib><creatorcontrib>Ruslami, Rovina</creatorcontrib><creatorcontrib>Alisjahbana, Bachti</creatorcontrib><creatorcontrib>van Crevel, Reinout</creatorcontrib><creatorcontrib>Hill, Philip C</creatorcontrib><title>Tuberculin skin test and Interferon-gamma release assay agreement, and associated factors with latent tuberculosis infection, in medical and nursing students in Bandung, Indonesia</title><title>PLoS ONE</title><description>Background No gold standard diagnostic test exists for latent tuberculosis infection (LTBI). The intra-dermal tuberculin skin test (TST) has known limitations and Interferon-gamma release assays (IGRA) have been developed as an alternative. We aimed to assess agreement between IGRA and TST, and risk factors for test positivity, in Indonesian healthcare students. Methods Medical and nursing students starting their clinical training were screened using IGRA and TST. Agreement between the two tests was measured using Cohen's Kappa coefficient. Logistic regression was used to identify factors associated with test positivity. Results Of 266 students, 43 (16.2%) were IGRA positive and 85 (31.9%) TST positive. Agreement between the two tests was 74.7% (kappa 0.33, 95% CI 0.21-0.45, P<0.0001). Students who had direct contact with family or friends with TB were less likely to be test positive using IGRA (AOR 0.18, 95% CI 0.05-0.64) and using TST (AOR 0.51, 95% CI 0.26-0.99). Conclusion Test positivity for LTBI was lower when measured by IGRA than by TST, with poor agreement between the two tests. Known close TB contact was unexpectedly negatively associated with positivity by either test. Longitudinal studies may be required to help determine the best test for LTBI in healthcare students in Indonesia.</description><subject>Care and treatment</subject><subject>Diagnosis</subject><subject>Evaluation</subject><subject>Health aspects</subject><subject>Interferon gamma</subject><subject>Tuberculin test</subject><subject>Tuberculosis</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>report</rsrctype><creationdate>2024</creationdate><recordtype>report</recordtype><sourceid/><recordid>eNqVT8tOw0AMXCGQKI8_4OAPaMMmoUlzBASCe-_IbJywZeNF640Q38UPYqoeuCJLtjWescfGXJW2KOu2vN7FOTGG4iMyFbbquk17c2QWZVdXq6ay9fGf_tScieysXdebplmY7-38SsnNwTPIu6ZMkgG5h2fOlAZKkVcjThNCokAoBCiCX4BjIpqI83LPVjA6j5l6GNDlmAQ-fX6DoBBnyIcrUbyA54Fc9pGX2sJEvXcY9lt4TuJ5BMlzr7JfKtzpYOZxqYZ6_U88XpiTAYPQ5aGem-LxYXv_pD4Dvej2mBM6jZ4m71QzeMVv203TrTvb2Prfgh8vfXZM</recordid><startdate>20240318</startdate><enddate>20240318</enddate><creator>Apriani, Lika</creator><creator>McAllister, Susan</creator><creator>Sharples, Katrina</creator><creator>Aini, Isni Nurul</creator><creator>Nurhasanah, Hanifah</creator><creator>Ratnaningsih, Dwi Febni</creator><creator>Indrati, Agnes Rengga</creator><creator>Ruslami, Rovina</creator><creator>Alisjahbana, Bachti</creator><creator>van Crevel, Reinout</creator><creator>Hill, Philip C</creator><general>Public Library of Science</general><scope/></search><sort><creationdate>20240318</creationdate><title>Tuberculin skin test and Interferon-gamma release assay agreement, and associated factors with latent tuberculosis infection, in medical and nursing students in Bandung, Indonesia</title><author>Apriani, Lika ; McAllister, Susan ; Sharples, Katrina ; Aini, Isni Nurul ; Nurhasanah, Hanifah ; Ratnaningsih, Dwi Febni ; Indrati, Agnes Rengga ; Ruslami, Rovina ; Alisjahbana, Bachti ; van Crevel, Reinout ; Hill, Philip C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-gale_infotracacademiconefile_A7869590603</frbrgroupid><rsrctype>reports</rsrctype><prefilter>reports</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Care and treatment</topic><topic>Diagnosis</topic><topic>Evaluation</topic><topic>Health aspects</topic><topic>Interferon gamma</topic><topic>Tuberculin test</topic><topic>Tuberculosis</topic><toplevel>online_resources</toplevel><creatorcontrib>Apriani, Lika</creatorcontrib><creatorcontrib>McAllister, Susan</creatorcontrib><creatorcontrib>Sharples, Katrina</creatorcontrib><creatorcontrib>Aini, Isni Nurul</creatorcontrib><creatorcontrib>Nurhasanah, Hanifah</creatorcontrib><creatorcontrib>Ratnaningsih, Dwi Febni</creatorcontrib><creatorcontrib>Indrati, Agnes Rengga</creatorcontrib><creatorcontrib>Ruslami, Rovina</creatorcontrib><creatorcontrib>Alisjahbana, Bachti</creatorcontrib><creatorcontrib>van Crevel, Reinout</creatorcontrib><creatorcontrib>Hill, Philip C</creatorcontrib></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Apriani, Lika</au><au>McAllister, Susan</au><au>Sharples, Katrina</au><au>Aini, Isni Nurul</au><au>Nurhasanah, Hanifah</au><au>Ratnaningsih, Dwi Febni</au><au>Indrati, Agnes Rengga</au><au>Ruslami, Rovina</au><au>Alisjahbana, Bachti</au><au>van Crevel, Reinout</au><au>Hill, Philip C</au><format>book</format><genre>unknown</genre><ristype>RPRT</ristype><atitle>Tuberculin skin test and Interferon-gamma release assay agreement, and associated factors with latent tuberculosis infection, in medical and nursing students in Bandung, Indonesia</atitle><jtitle>PLoS ONE</jtitle><date>2024-03-18</date><risdate>2024</risdate><volume>19</volume><issue>3</issue><spage>e0299874</spage><pages>e0299874-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Background No gold standard diagnostic test exists for latent tuberculosis infection (LTBI). The intra-dermal tuberculin skin test (TST) has known limitations and Interferon-gamma release assays (IGRA) have been developed as an alternative. We aimed to assess agreement between IGRA and TST, and risk factors for test positivity, in Indonesian healthcare students. Methods Medical and nursing students starting their clinical training were screened using IGRA and TST. Agreement between the two tests was measured using Cohen's Kappa coefficient. Logistic regression was used to identify factors associated with test positivity. Results Of 266 students, 43 (16.2%) were IGRA positive and 85 (31.9%) TST positive. Agreement between the two tests was 74.7% (kappa 0.33, 95% CI 0.21-0.45, P<0.0001). Students who had direct contact with family or friends with TB were less likely to be test positive using IGRA (AOR 0.18, 95% CI 0.05-0.64) and using TST (AOR 0.51, 95% CI 0.26-0.99). Conclusion Test positivity for LTBI was lower when measured by IGRA than by TST, with poor agreement between the two tests. Known close TB contact was unexpectedly negatively associated with positivity by either test. Longitudinal studies may be required to help determine the best test for LTBI in healthcare students in Indonesia.</abstract><pub>Public Library of Science</pub><doi>10.1371/journal.pone.0299874</doi></addata></record>
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source	Publicly Available Content Database; PubMed Central
subjects	Care and treatment Diagnosis Evaluation Health aspects Interferon gamma Tuberculin test Tuberculosis
title	Tuberculin skin test and Interferon-gamma release assay agreement, and associated factors with latent tuberculosis infection, in medical and nursing students in Bandung, Indonesia
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