Tuberculosis Skin Test Screening in the National Tuberculosis Program of Trinidad and Tobago.

Vijay Kumar Chattu,Nikesha Pooran,Sateesh Sakhamuri,Vasishma Kanita Persad,Neelmani Pierre,Shivannie Persad,Shastri Motilal,Akua Mosi Pottinger,Liam J Pounder

doi:10.3390/healthcare8030236

Abstract

Globally, a quarter of the population is infected with tuberculosis (TB), caused by Mycobacterium tuberculosis. About 5–10% of latent TB infections (LTBI) progress to active disease during the lifetime. Prevention of TB and treating LTBI is a critical component of the World Health Organization’s (WHO) End TB Strategy. This study aims to examine the screening practices for prevention and treatment employed by the National Tuberculosis Program of Trinidad and Tobago in comparison to the WHO’s standard guidelines. A cross-sectional retrospective study was conducted from the TB registers (2018–2019) for persons aged 18 years and above with recorded tuberculin skin test reactions (TST). Bivariate comparisons for categorical variables were made using Chi-square or Fisher’s exact test. Binary logistic regression was used for exploring predictors of TST positivity with adjustment for demographic confounders in multivariable models. Of the total 1972 eligible entries studied, 384 (19.4%) individuals were tested positive with TST. TB contact screening (aOR 2.49; 95% CI 1.65, 3.75) and Bacillus Calmette–Guerin (BCG) vaccination status (aOR 1.66; 95% CI, 1.24 to 2.22) were associated with a positive TST reaction, whereas, preplacement screening failed to show such association when compared to those screened as suspect cases. The findings suggest that TB contact screening and positive BCG vaccination status are associated with TST positivity independent of age and gender.

Highlights

Tuberculosis (TB) is a highly infectious disease caused by the bacterium Mycobacterium tuberculosis.As stated by the World Health Organization (WHO), it is the single leading cause of infection and ranks among the top 10 mortality rates worldwide
Latent TB infection (LTBI) is a dormant state of the bacteria, exhibits immune response to mycobacterial antigens with no symptoms related to disease [3]
The method of administration and interpretation of reaction to TST used by the National Tuberculosis Program (NTP) are as per the Center for Disease Control and Prevention (CDC) guidelines [10]

Summary

Introduction

Tuberculosis (TB) is a highly infectious disease caused by the bacterium Mycobacterium tuberculosis.As stated by the World Health Organization (WHO), it is the single leading cause of infection and ranks among the top 10 mortality rates worldwide. Trinidad and Tobago is a high-income southern Caribbean country, has been listed as a low TB burden country by WHO based on its incidence rate of 21 cases per 100,000 [2]. TB exists in two forms, active disease (primary and secondary) and latent infection. Latent TB infection (LTBI) is a dormant state of the bacteria, exhibits immune response to mycobacterial antigens with no symptoms related to disease [3]. About a quarter of the world’s population is estimated to be TB infected [4], with approximately 5–10% likely to develop active TB disease within their lifespan [5]. Positive tests for LTBI can be used to support the diagnosis of active TB, especially in resource-limited settings

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