Skin Test Reading Research Articles

Vitamin D deficiency is associated with tuberculosis infection among household contacts in Ulaanbaatar, Mongolia.

BACKGROUND: Vitamin D deficiency (VDD) is a known risk factor for tuberculous infection. We investigated if VDD is a risk factor for tuberculous infection among the household contacts (HHCs) of patients with tuberculosis (TB) in Mongolia.MATERIALS and METHOD: All HHCs of TB patients diagnosed in Khan-Uul District, Mongolia, were enrolled. The serum level of 25-hydroxyvitamin D [25(OH)D] was detected and TB infection determined using QuantiFERON-TB Gold Plus (QFT-Plus). A tuberculin skin test (TST) reading >10 mm was considered to be positive. Epidemiological and bacteriological data were collected from routine surveillance of the National Tuberculosis Programme.RESULTS: Among study participants, 48.2% (135/285) were QFT-Plus-positive. Of QFT-positive HHCs, 77.0% (104/135) were TST-positive and the overall concordance of tests was low (κ 0.374, P < 0.001). A low serum level of 25(OH)D was an independent predictor for QFT-Plus positivity (P < 0.001). CD8+ T-cell stimulation measured by QFT-Plus had borderline association with the serum level of 25(OH)D (P = 0.089).CONCLUSION: We showed a high rate of TB infection among HHCs in Mongolia. QFT-Plus could decrease the number of people requiring TB preventive treatment, in addition to aiding detection of new TB infection. A low serum level of vitamin D was an independent predictor of TB infection, but not a predictor of stimulation of CD8+ T cells.

Prevalence of latent pulmonary tuberculosis in children with diabetes mellitus attending a Tertiary Care Hospital in Mansoura: a cross-sectional study

Aims Tuberculosis (TB) and diabetes mellitus are closely associated with each other. We conducted a cross-sectional study to assess the prevalence and pattern of latent pulmonary TB in diabetic children using a combined screening tool. Settings and design A cross-sectional study was carried out in a Tertiary Care Hospital, Mansoura, Egypt, during the period from January to December, 2016. Materials and methods The study enrolled all diabetic children with the inclusion criteria who were available during the study period and attending the endocrinology outpatient clinics or admitted in the inpatient ward. A total of 70 diabetic patients completed tuberculin skin test (TST) reading, and their results were compared with those of 70 healthy controls. All patients were subjected to detailed medical history, complete physical examination, and laboratory and radiological evaluation. TB screening was done for both groups using TST, sputum microscopy and culture, and chest radiography. We used TST induration diameter more than 6 mm as the cut-off value to determine test positivity. Results A total of 53 (75.7%) patients of the studied diabetic group were poorly controlled. TST was positive in 30% of the screened diabetic patients. Test positivity was significantly higher among diabetic group when compared with control group. TST positivity was significantly higher in poorly controlled diabetic cases. There was a statistically significant negative correlation between TST induration diameter and HBA1C. Conclusion Diabetic patients are more vulnerable to latent pulmonary TB. The association between poor glycemic control and latent pulmonary TB among diabetic patients was evident. Combining TST with sputum culture and chest radiography did not improve screening results.

Non-completion of latent tuberculous infection treatment among children in Rio de Janeiro State, Brazil.

Children with latent tuberculous infection (LTBI) are particularly vulnerable to progression to active tuberculosis (TB), and are thus a priority target for isoniazid preventive therapy (IPT). However, adherence to IPT is poor. We hypothesised that children from poorer families, with reduced access to health care and lack of understanding about the disease are more likely to default from IPT. A questionnaire was administered to close child contacts or their parents at the time of prescribing IPT in three cities in Rio de Janeiro State. The children were followed prospectively. Treatment adherence was defined as taking 80% of prescribed doses. Among 1078 children screened for LTBI, 97 (8.9%) did not return for tuberculin skin test (TST) reading; 332 (30.8%) were TST-positive; 115/332 (34.6%) were prescribed IPT, 6 of whom did not initiate treatment and 11 did not adhere during the first 2 months; 25 additional children did not complete IPT. Overall non-completion was four times more frequent among those with lower income. Health care access and knowledge did not improve treatment completion. Substantial losses to follow-up occurred before IPT prescription; this should be further investigated. Among the children who started isoniazid, low income, but not difficult access or poor knowledge, increased the risk of treatment non-completion.

Multi Insulin Sensitization with Tolerante to New Therapeutic Option: Degludec

Introduction: Insulin has been used for the treatment of diabetes mellitus (DM) since 1920. At first, the animal insulins were available for human use having frequent allergic reactions due to the differences in amino acid sequences with human insulin. Currently, with the use of human insulin, the prevalence of these reactions is around 2% and less than a third of these events were associated with insulin itself. These cases are associated with their additives or preservatives. The most commonly hypersensitivity reaction found is type I. In these cases, the use of a rapid-acting insulin is the best therapeutic alternative. We report the case of a multi-sensibilizated patient to insulin presenting tolerance to the ultralong-acting: Degludec insulin. Case report: Female patient, 74, referring use of NPH (Neutral Protamine Hagedorn) human insulin for 5 years, with papule at the site of application of the insulin minutes after application. She visited the Allergy and Immunology Clinic of the State Public Servant Hospital of Sao Paulo referring anaphylaxis few minutes after application of human insulin (NPH). Also reported extensive local reaction due the use of detemir, and local reaction to lispro insulin. We conducted immediate skin test reading with insulins: Regular, Lispro, NPH, Detemir and Degludeca at a concentration of 1:1; addition of the additive (Protamine 10 mg/ml) and latex. Presented positive test for all insulins, except Degludeca and presented negative test for protamine and latex. Conclusion: we found no common additive to all insulins, which is not present in degludeca insulin (Tresiba ®), enhancing insulin allergy hypothesis. Patient currently tolerates the use of long-acting insulin (Degludeca) and has adequate control of their blood sugar. In this case the patient had no insulin reaction prolonged action and this may be a new therapeutic option to be tested in patients with allergic reactions to insulin.

Adverse events and association with age, sex and immunological parameters of Q fever vaccination in patients at risk for chronic Q fever in the Netherlands 2011

BackgroundFollowing a large Q fever outbreak in the Netherlands, patients at risk for chronic Q fever received a whole-cell Q fever vaccine. Sensitized people were excluded based on pre-vaccination screening with skin test (ST) and serology. An investigational IFN-γ-production assay was added. No previous experience existed for Q fever vaccination in this patient risk-group with predefined cardiac valvular anomalies or aortic aneurysm/prosthesis and many co-morbidities. We studied the adverse events (AE) and their association with patient characteristics and immunological parameters. MethodsAE registration covered the week after skin test and 90 days following vaccination, with the use of diaries, interviews and spontaneous reports. Serious (S)AE were assessed immediately to ensure safety. We coded AE according to reported severity. Univariate and multivariate analysis addressed associations. ResultsPre-vaccination screening led to exclusion of 182 patients with positive serology and 207 patients with positive skin test-reading. The skin test did not lead to any causally related SAE. Subsequent vaccination of 1370 patients did not reveal unexpected AE; however, 80% of vaccinees reported local AE (in 26% of these pronounced or extensive). The two causally related SAE (0.1%) both concerned a persistent subcutaneous injection site mass. AE were more frequent in women, younger patients, and those without immunosuppressive co-morbidity/medication. The occurrence of local AE after skin test was associated with pre-vaccination positive serology and high IFN-γ production. This was also true for local AE following vaccination, with a strong association with local AE after skin test as well. The proportion of vaccinees with positive serology and positive IFN-γ values 6 months after vaccination was higher in those with local AE after skin test or after vaccination (non-significant, probably due to small numbers). ConclusionQ fever vaccination was safe but reactogenic in this high-risk patient-group. Rates of local AE were higher in women, younger age groups and in those with positive immunological parameters. Vaccinees with local AE after skin test or after vaccination appear to have more pronounced post-vaccination immune responses.

Granulomatous cervicofacial lymphadenitis in children: a nine-year study in Singapore.

Granulomatous cervicofacial lymphadenitis (GCL) is not uncommon in children. Nontuberculous mycobacteria (NTM) seem to be the predominant cause. We sought to study the clinical and microbiological profile of patients with GCL, and identify features that may impact outcome. Children aged < 16 years who presented to KK Women's and Children's Hospital, Singapore, between January 1998 and December 2006, and who had GCL were identified from laboratory records. Clinical and laboratory data was collected and analysed for risk factors for patients with positive lymph node cultures, and for patients with and without recurrence after treatment. In all, 60 children were identified, with a median age of 56 (interquartile range [IQR] 34-101) months. Median duration of symptoms before presentation was 5 (IQR 4-8) weeks. The majority presented with single (73.3%) or unilateral (96.7%) lymphadenopathy, located in the submandibular, preauricular/parotid or infra-/post-auricular region (76.7%). Out of 51 patients, 26 (51.0%) had a tuberculin skin test reading of ≥ 10 mm. Out of 52 patients, 10 (19.2%) had positive mycobacterial cultures, which included seven isolates of NTM. Out of 34 cases, tuberculous polymerase chain reaction was positive in 11 (32.4%). With regard to recurrence after initial treatment, age < 5 years at presentation was found to be a predictor for recurrence (p = 0.008), while initial complete excision of affected nodes predicted no recurrence (p = 0.003). In our study, younger age was noted to be associated with a higher chance of recurrence, while complete excision of the involved node at initial presentation predicted non-recurrence.

Contact screening in tuberculosis: can we identify those with higher risk?: Table 1–

To the Editor: Contact screening, as a strategy to identify recently infected individuals, is part of the tuberculosis (TB) elimination strategy. It follows risk stratification concerning the infectiousness of the index patient, the duration and proximity of exposure, and the susceptibility of the contact [1, 2]. For its optimisation it is important to know which risk factors are associated with Mycobacterium tuberculosis transmission in order to not over screen or lose at-risk contacts. In view of that, this study aims to identify potential risk factors for M. tuberculosis transmission among contacts of pulmonary TB patients, in a Portuguese TB reference centre. From January to December of 2011, all contacts of confirmed pulmonary TB patients, screened in the TB centre, were questioned about their exposure to the index patient through a questionnaire completed during the medical appointment. Both household and casual contacts were screened, independent of their cumulative exposure. Contacts excluded: those with exposure outdoors ( e.g. in the street); those with incomplete characterisation of exposure ( e.g. index patients for whom we did not know the symptomatic period); those non-compliant with screening ( e.g. contacts who failed tuberculin skin test (TST) reading); and those with a past history of M. tuberculosis infection or TB disease ( e.g. contact´s verbal report of previous TB disease, contact with a pulmonary TB patient or treatment for latent tuberculosis infection (LTBI)). Contacts of patients with a diagnosis of pulmonary TB were identified for screening at the moment of the index patient diagnosis. The index patient was asked to identify contacts within the family, social and work spheres. Furthermore, some other …

Intensified Case Finding for Tuberculosis in Prevention of Mother-to-Child Transmission Programs: A Simple and Potentially Vital Addition for Maternal and Child Health

The intersection of HIV and tuberculosis (TB) poses a serious threat to HIV-infected women and their children. The majority of patients with TB in sub-Saharan Africa are infected with HIV and together the overlapping epidemics synergistically accelerate illness and death. Escalating case rates increased mortality and the recent emergence of extensively drug-resistant TB highlights how catastrophic a once preventable and curable disease has become among people with HIV/AIDS. The HIV epidemic requires new strategies to control TB in high-burden areas especially as women of reproductive age are disproportionately affected by the epidemic. Intensified case finding for TB has the potential to reduce morbidity and mortality for people living with HIV especially pregnant women their families and infants. (excerpt)

Assessment of Tuberculosis Screening and Management Practices of Large Jail Systems

This descriptive study sought to explore the use and timeliness of tuberculosis (TB) screening and management activities in jail facilities. Study personnel visited 20 large U.S. jail systems and reviewed the medical records of 56 inmates who had recently been evaluated for TB disease and 376 inmates who were diagnosed with or confirmed to have latent TB infection (LTBI). Data from these records were analyzed to determine completion and timeliness of screening, diagnostic, and treatment activities. In 14% of 56 inmates evaluated for TB disease and 24% of 376 inmates with LTBI, chest radiographs were either not performed or not documented. Of 48 inmates evaluated for TB disease who were not receiving treatment when admitted to jail, 10 had no record of sputum collection being done. A mean delay of 3.1 days occurred from symptom report to respiratory isolation. Time from tuberculin skin test reading to chest radiograph reading was a mean of 5.3 days in inmates evaluated for TB disease and a mean of 7.0 days in inmates with LTBI. Follow-up was arranged for 91% of released inmates who were on treatment for TB disease and only 17% of released inmates who were on treatment for LTBI. Jail health information systems should be augmented to better document and monitor inmate health care related to TB. Completion rates and timeliness of TB screening, diagnostic, and treatment measures should be evaluated to identify areas needing improvement. Finally, mechanisms for continuity of care upon inmate release should be enhanced to promote therapy completion and prevent TB transmission in the community.

Characteristics of injection drug users who utilize tuberculosis services at sites of the Baltimore city needle exchange program.

To describe characteristics of needle-exchange program (NEP) participants who utilized tuberculosis services from an NEP site. Between June 1998 and May 1999, tuberculosis services were advertised and offered to Baltimore, Maryland, NEP participants. Demographic and tuberculosis-specific data were collected on participants who self-selected into services. Analyses were based on being tuberculin skin tested, returning for a skin test reading, and testing tuberculin positive. Among 691 contacts with NEP participants, this service performed 296 tuberculin tests, with an 84% return rate for skin test reading. Participants were 32% female, 87% African American, and 11% employed. Higher frequency of NEP visits was positively associated with requesting tuberculosis services and returning for skin test reading. Among those who returned for skin test reading, longer smoking duration and problems getting food in the past year due to a lack of money were associated with a positive test. Utilization of a tuberculosis service and high return rates can be achieved among NEP participants without formal recruitment strategies. Frequent exchange appears to facilitate return visits for NEP-based tuberculosis screening, which may imply accessibility for frequent exchangers. More extensive health services at sites of the Baltimore NEP appear to be warranted, with particular attention paid to effectiveness for frequent exchangers.

An assessment of selected preventive screenings among children aged 12 to 35 months in a hospital‐based, Medicaid managed care practice

ABSTRACTObjectives The goal of this study was to assess (i) whether preschool children enrolled in a hospital‐based, Medicaid managed care practice had received recommended preventive screenings, including blood lead, hematocrit and tuberculosis testing, and (ii) the prevalence of positive results in these screens.Design and methods All children between 12 and 35 months of age who had been continuously enrolled in the practice for the last 6 months of 1996 were included in the study, regardless of their visit frequency. Medical records were reviewed for the study children. The dates and results of all blood lead, hematocrit and tuberculosis tests were abstracted.Results Eight hundred and twelve children met the study inclusion criteria. All but two of these children had a hospital medical record available for review. Six hundred and ninety of the 812 children (85.0%) had a documented blood lead test. Of those screened, more than one‐quarter (190 of 690; 27.5%) had at least one result ≥ 10 μg/dL. A hematocrit result was documented for 742 of the study children (91.4%), and 377 of these children (50.8%) were anemic on at least one test (defined as a hematocrit two standard deviations below published norms). Two‐thirds of study children (536) had documentation of a tuberculosis screen being performed, with two‐thirds of these having a documented reading. None of the 342 children with a documented tuberclin skin test reading had a positive test.Conclusions Screening rates were relatively high in this study group, especially when one considers that the denominator for screening rates was based on enrollment in the practice, regardless of whether or not the child had been seen. The results of these screening tests provide evidence for the high burden of lead poisoning and anemia in this low‐income population.Implications for practice This study demonstrates that it is feasible to carry out assessments basedon defined primary care responsibilities, allowing for a more population‐based approach to health care in hospital‐based clinics.

Evaluation of the two-step tuberculin skin test in health care workers at an inner-city medical center.

The increased rate of tuberculosis (TB) infection and transmission from patients to health care workers (HCWs) has brought awareness of the need for better surveillance programs. The two-step purified protein derivative (PPD) skin test decreases the misinterpretation of a "boosted reaction" as a recent infection with Mycobacterium tuberculosis in HCWs. We reviewed the medical records of 4082 HCWs at an inner-city medical center who had PPD skin-testing performed as a component of the TB medical surveillance program during the years 1994 and 1995. Of those HCWs tested, 3896 (95.4%) returned for the PPD skin-test evaluation. Of those 3896 HCWs, 3659 (93.9%) had a negative baseline PPD skin test, and 237 (6.1%) had a positive skin test. Of those HCWs with a negative baseline skin test, 252 (6.9%) were eligible for the second PPD skin test. Of the 241 who returned for their second PPD skin-test reading, six (2.5%) had positive results. All six cases were foreign-born physician residents with a previous history of Bacille bilié de Calmette-Guérin (BCG) vaccination. We conclude that the two-step PPD skin test method is not indicted for HCWs at this urban medical facility.

Monetary versus nonmonetary incentives for TB skin test reading among drug users

Background: In a prior study, we reported that monetary incentives were effective in increasing return for tuberculosis (TB) skin test reading. The purpose of this study was to compare the effects of monetary versus nonmonetary incentives and a theory-based educational intervention on return for TB skin test reading in a sample of newly recruited active injection and crack cocaine users, and to determine the prevalence of TB infection in this sample. Methods: Active injection drug and/or crack cocaine users ( n = 1,078), recruited using street outreach techniques, were skin tested for TB. They were randomly assigned to 1 of 5 experimental treatment conditions: $10 cash, grocery store coupons, bus tokens/fast-food coupons, motivational education, or usual encouragement to return. Nonmonetary incentives had a $10 value, and all incentives were provided at return for skin test reading. Results: Ninety-five percent of those who received $10 returned for skin test reading compared to 86% of those who received grocery store coupons and 83% of those who received either bus tokens or fast-food coupons. In contrast, only 47% of those who received the educational session and only 49% of those who received usual encouragement returned for skin test reading. The prevalence of a positive tuberculin test was 21%, and was similar for crack cocaine and injection drug users. Conclusions: Nonmonetary and monetary incentives dramatically increased the return rate for TB skin test reading among drug users who are at high risk of TB infection. Nonmonetary incentives were somewhat less effective than monetary incentives.

Does HIV infection alter transmission of tuberculosis in households

DOES HIV INFECTION ALTER TRANSMISSION OF TUBERCULOSIS IN HOUSEHOLDS. D. Guwatudde, P. Musoke, M. Nakakeeto, G. B. Bukenya, R. D. Mugerwa, J. EUner, C. Whalen. CEU, Makerere University, Kampala, Uganda. Objec t i ve : HIV infection confers the greatest known risk for TB, both primary & reactivation of latent infection. Infection with HIV and M. tuberculosis (MTB) is common in Uganda. In this setting, HIV infection may alter the transmission dynamics of MTB. We examined the effect of HIV infection on transmission of MTB in households. Design: Cross-sectional prevalence study. Set t ing: Index TB patients with sputum smear positive TB were identified at a major TB clinic in Kampala, Uganda. Their full-time household contacts were evaluated by: Mantoux purified protein derivative (PPD) skin-test, chest x-ray, medical history & physical examination, TB symptoms, HIV serology and other characteristics. Participants: Household contacts of index TB patients. Interventions: Tuberculin skin-test placed on volar aspect of the left forearm using 0.1 ml of 5 T U of PPD. Main Outcome Measure(s): Rate of PPD positivity and active TB. A PPD skin-test reading ~<5mm was defined positive, implying infection with MTB. Resul t s : 750 contacts were ewduated. 410 were contacts of HIV+ index TB patients. In contacts of index TB patients without cavitary disease, no significant differences were noted in rates of PPD positivity between contacts of HIV+ and H I V index patients. However, m contacts of index TB patients with cavitary disease, significant differences were noted in PPD positivity, between contacts of HIV+ and HIV index patients, [OR 4.5, 95% (21: = 1.79-11.1]. Other risk factors for PPD-positivity noted were: age of the contact and number of people in household. No significant risk of active TB disease was noted between contacts of HIV+ and H I V index patients. Risk factors for active TB noted were: cavitation in the index patient, age of contact, HIV infection in contact, and sharing of a bedroom or bed with the index patient. Conclusions: The effect of H1V infection in an index TB patient on infection with MTB in contacts depends on the chest xray presentation of TB in the index patient. There is no increased risk for active TB disease due to HIV infection in the index TB patient. TO STUDY THE SOCIO.CULTURAL ASPECTS OF TUBERCULOSIS WITH REFERENCE TO IDENTI. FICATION OF LOCAL TERMINOLOGIES USED IN THE TRIBAL L A N G U A G E IN A TRIBAL AREA IN ORISSA, INDIA. K. R. John, V. Philip, J. Thomas, N. Philip. CEU, Christian Medical College and Hospital, Vellore, India; Asha Kiran Hospital Lamtaput, Orissa, India. Objec t ive : To study the perceptions regarding symptoms, aetiology, preventability, mode of transmission, and curability. Des ign : Qualitative techniques of focus group discussion, in-depth interviewing, and body mapping were used. Set t ing: The tribal population in 3 villages in Lamtaput, Orissa is known fi~r its traditional culture because of the remoteness was studied. The language is not in the written form and the tribal dialect has regional differences. Participants: 8 focus groups and 5 in-depth interviews were conducted incorporating the different sections of the population. Main Outcome Measure(s): The perceptions about pulmonary tuberculosis. Results: The term khogly was used fi)r cough, term sukgh sony was associated with weight loss. Chest pain was associated with the terminology bhukk dukha. Khan&lmal was associated with lymphadenopathy. There was no local term which associated all these symptoms together as tuberculosis. They were of the opinion that the word TB disease was recently introduced. The etiology of TB as perceived in the order of priority were drinkrag, smoking, working severely and consuming fi~od grown by the use of fertilizers. The weak hmg syndrome was not reported m any of the discussions. The Desia language terminologies were not known m the study area. There was total disagreement about the role of sputum being the agent for the spread of TB. There were no barriers in the care being given. There are strong objections in handling of sputum fi)r testing. Concerning the body image the opinion was that lung is one sided and there are 5 ribs protecting it. Conclusions: The perceptions of individual symptoms need to be connected to get a fi,ller understanding of TB during training. There is also need to remove barriers m providing sputum for testing through the tribal health workers.

A tuberculin screening and isoniazid preventive therapy program in an inner-city population.

As tuberculosis transmission decreases, case rates decline and an increasing proportion of cases arises from the pool of persons with latent infection. Elimination of tuberculosis will require preventing disease from developing in infected persons. From 1994 to 1996 the Atlanta TB Prevention Coalition conducted a community-based tuberculin screening and isoniazid preventive therapy project among high-risk inner-city residents of Atlanta, Georgia. We established screening centers in outpatient waiting areas of the public hospital serving inner-city residents, the city jail, clinics serving the homeless, and with outreach teams in neighborhoods frequented by drug users. All services were provided free. A total of 7,246 persons participated in tuberculin testing; 4,701 (65%) adhered with skin test reading, 809 (17%) had a positive test, 409 (50%) fit current guidelines for isoniazid preventive therapy, 84 (20%) we intended to treat completed therapy. The major limitations of this community-based tuberculin screening and preventive therapy project were the low proportion of infected individuals who were eligible for isoniazid preventive therapy and the poor adherence with a complete regimen among those we intended to treat. For community-based programs to be efficacious, preventive therapy regimens that are of shorter duration and safe for older persons will need to be implemented.

Tuberculosis screening and compliance with return for skin test reading among active drug users.

This study assessed the independent and combined effects of different levels of monetary incentives and a theory-based educational intervention on return for tuberculosis (TB) skin test reading in a sample of active injection drug and crack cocaine users. Prevalence of TB infection in this sample was also determined. Active or recent drug users (n = 1004), recruited via street outreach techniques, were skin tested for TB. They were randomly assigned to 1 of 2 levels of monetary incentive ($5 and $10) provided at return for skin test reading, alone or in combination with a brief motivational education session. More than 90% of those who received $10 returned for skin test reading, in comparison with 85% of those who received $5 and 33% of those who received no monetary incentive. The education session had no impact on return for skin test reading. The prevalence of a positive tuberculin test was 18.3%. Monetary incentives dramatically increase the return rate for TB skin test reading among drug users who are at high risk of TB infection.

Pseudo-Outbreak of Tuberculosis Infection Due to Improper Skin-Test Reading

Pseudo-Outbreak of Tuberculosis Infection Due to Improper Skin-Test Reading

Tuberculin sensitivity and HIV-1 status of patients attending a sexually transmitted diseases clinic in Lusaka, Zambia: a cross-sectional study

A cross-sectional study to estimate the prevalence of latent tuberculosis (TB) in a group of Zambians at high risk of human immunodeficiency virus type 1 (HIV-1) infection and to examine the effect of HIV-1 infection on the tuberculin response was conducted in the University Teaching Hospital in Lusaka, Zambia during July to September 1990. Patients were selected from those presenting to the out-patient clinic for first referral with either sexually transmitted or skin diseases. 268 adults were included in the study; 158 (59%; 95% confidence interval [CI] = 53–65%) were HIV-1 antibody positive. Of 82 HIV-1 negative participants who returned for Mantoux skin test reading, 51 (62%; 95% CI = 57–67%) had a positive test reaction (diameter ⩾10 mm) after receiving 2 units of RT-23 tuberculin. Of 106 HIV-1 positive participants who returned, only 32 (30%; 95% CI = 26–34%) had a diameter ⩾10 mm. Nine (28%) of the HIV-1 positive and Mantoux positive participants had large reactions ⩾30 mm, compared to 4 (8%) of the HIV-1 negative, Mantoux positive participants ( P = 0.03). Results in the HIV-1 negative group indicated a prevalence of latent TB of 62% in this population. HIV-1 infection was associated with a much higher frequency of negative response to tuberculin and with a few large skin test responses. Thus, in populations where HIV seropositivity is high, Mantoux skin tests cannot be used to assess those with latent TB who might benefit from chemoprophylaxis.

Health Beliefs and Intentions: Predictors of Return Compliance in a Tuberculosis Detection Drive1

A prospective design was employed to study the ability of various factors to predict return compliance in a tuberculosis detection drive. Five hundred fiftythree participants in the drive were asked to complete a questionnaire tapping their views of TB (based on the Health Belief Model) and their intentions to return for the recommended skin test reading. Behavioral intention was found to be an important predictor of return rates, and the inclusion of the HBM variables aided in the classification noncompliers. Practical and theoretical implications of these findings are discussed.