High Latent Tuberculosis Infection Test Conversion Rates among Healthcare Workers in the Country of Georgia 公开

Abstract

Background: There are very limited data on serial testing of healthcare workers (HCWs)
with interferon gamma release assays (IGRAs) for latent tuberculosis infection (LTBI).
The purpose of this study was to determine the prevalence and risk factors for LTBI
among Georgian HCWs using the tuberculin skin test (TST) and QuantiFERON-TB Gold
In-tube assay (QFT), in addition to determining the rates and risk factors for TST and
QFT conversions (change from a negative to positive test result).

Methods: A prospective longitudinal study was conducted among Georgian HCWs.

Results: Among 319 HCWs enrolled, 259 (81%) were female; mean age was 41 years;
285 (89%) reported prior BCG vaccination; 194 (60%) worked in healthcare facilities
specializing in TB. HCWs from TB facilities had higher QFT and TST positivity rates
than those from non-TB facilities: 107/194 (55%) vs. 30/125 (31%) QFT positive
(p<0.0001) and 128/189 (69%) vs. 64/119 (54%) TST positive (p=0.01). There was fair
agreement between the TST and QFT diagnostic tests (70%, kappa=0.42, 95% CI 0.31-
0.52). In multivariate analysis, frequent contact with TB patients was associated with
increased risk of a positive QFT (OR 3.04, 95% CI 1.79-5.14) but not with positive TST
(OR 1.29, 95% CI 0.76-2.18). Age in years was associated with increased risk of positive
QFT (OR 1.05 per year, 95% CI 1.01-1.09) and TST (OR 1.05, 95% CI 1.01-1.10). High
rates of HCW conversion were seen (QFT conversion rate: 22.8/100 person-years and
TST conversion rate: 17.1/100 person-years). TST conversion was associated with
working in a TB facility (p=0.04), whereas QFT conversion was not (p=0.43). In
multivariate analysis, female gender was associated with decreased risk of TST
conversion (OR 0.05, 95% CI 0.01-0.43) and age in years was associated with increased
risk of QFT conversion (1.07, 95% CI 1.01-1.13).

Conclusion: A high prevalence of LTBI was seen among Georgian HCWs, especially
those working at TB facilities. Frequent patient contact was associated with increased
risk of LTBI when using QFT. High conversion rates were found among Georgian
HCWs, particularly at TB facilities. These data highlight the need for effective TB
infection control measures.

Table of Contents

TABLE OF CONTENTS

Introduction………………………………………………………………….. 1-2
Background…………………………………………………………………... 2-8
Methods……………………………………………………………………… 8-16
Results……………………………………………………………………….. 16-24
Discussion……………………………………………………………………. 24-31
References…………………………………………………………………… 32-35
Figures……………………………………………………………………….. 36-38
Tables………………………………………………………………………....39-49
Appendix…………………………………………………………………….. 50

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Laney Graduate School
Department	Clinical Research Curriculum Program
Degree	MS
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
关键词	latent Georgia interferon gamma release assay Quantiferon tuberculosis tuberculin skin test IGRA
Committee Chair / Thesis Advisor	Blumberg, Henry Michael, Emory University
Committee Members	Ofotokun, Igho, Emory University Klein, Mitchel, Emory University

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