Latent tuberculosis infection in health care workers in low and middle-income countries
Health care workers (HCWs) are at increased risk of latent tuberculosis infection (LTBI) and TB disease. We conducted an updated systematic review of the prevalence and incidence of LTBI in HCWs in low and middle-income countries (LMICs), associated factors, and infection control practices. We searched Medline, Embase, and Web of Science (01 January 2005â€“20 June 2017) for studies published in any language. We obtained pooled estimates using random effects methods, and investigated heterogeneity using meta-regression. Included were 85 studies (32â€Š630 subjects) from 26 LMICs. Prevalence of positive tuberculin skin test (TST) was 14â€“98% (mean 49%); of Interferon-gamma release assays (IGRA) 9â€“86% (mean 39%). Countries with TB incidence â‰¥300/100â€Š000 had the highest prevalence (TST: pooled estimate 55%, 95% CI 41â€“69%; IGRA: 56%, 39â€“73%). Annual incidence, estimated from TST, was 1â€“38% (mean 17%); from IGRA 10â€“30% (mean 18%). The prevalence and incidence of a positive test was associated with years of work, work location, TB contact, and job category. Only fifteen studies reported on infection control measures in health care facilities, with limited implementation. HCWs in LMICs in high TB incidence settings remain at increased risk of acquiring LTBI. There is an urgent need for robust implementation of infection control measures.
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Conflict of interest: Dr. Apriani has nothing to disclose.
Conflict of interest: Dr. McAllister has nothing to disclose.
Conflict of interest: Dr. Sharples has nothing to disclose.
Conflict of interest: Dr. Alisjahbana has nothing to disclose.
Conflict of interest: Dr. Ruslami has nothing to disclose.
Conflict of interest: Dr. Hill has nothing to disclose.
Conflict of interest: Dr. Menzies has nothing to disclose.
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