USPSTF recommends screening for latent TB infection in at-risk persons

In its statement, published in JAMA (Journal of the American Medical Association), the USPSTF recommends screening people at increased risk for latent tuberculosis infection.

The document states, "The USPSTF concludes with moderate certainty that there is a moderate net benefit in preventing active tuberculosis disease by LTBI screening in people at increased risk for tuberculosis infection."

Tuberculosis in the US is an important preventable disease, including active tuberculosis, which may be infectious, and LTBI, which is asymptomatic and not infectious but can later lead to active disease.

The final recommendation statement, a grade B recommendation, is an update to the 2016 recommendation. The task force commissioned a systematic review on LTBI screening and treatment in asymptomatic adults seen in primary care and the accuracy of LTBI screening tests. The review focused on the harms and benefits of LTBI screening and treatment in asymptomatic adults in primary care and the accuracy of LTBI screening tests.

Daniel E. Jonas, University of North Carolina at Chapel Hill Evidence-Based Practice Center in Research Triangle Park, and colleagues reviewed the evidence on the benefits and harms of screening for and treatment of LTBI in adults. Data were obtained from 113 publications (112 studies comprising 69,009 patients). The researchers found that none of the studies directly evaluated the benefits and harms of screening.

In the US, two types of screening tests for LTBI are available -- the tuberculin skin test (TST) and the interferon-gamma release assay (IGRA).

Pooled estimates for the sensitivity of the tuberculin skin test were found to be 0.80, 0.81, and 0.60 at the induration thresholds of 5-, 10-, and 15-mm, respectively, while the sensitivity of interferon-gamma release assays ranged from 0.81 to 0.90. For screening tests, the pooled specificity estimates ranged from 0.95 to 0.99.

For isoniazid versus placebo, a good-quality randomized clinical trial showed a relative risk for progression to active tuberculosis at five years of 0.35 and increased hepatotoxicity. Based on a previously published meta-analysis, multiple regimens were efficacious versus placebo or no treatment.

"Screening for latent tuberculosis infection in persons at increased risk is effective for identifying the infection so that it can be treated timely before it advances to active tuberculosis," Gbenga Ogedegbe, a task force member, said in a statement.

Based on these findings, the USPSTF concludes there is a moderate net benefit for preventing active tuberculosis disease by screening symptomatic persons at increased risk for infection for LTBI.

B recommendation: Screening is recommended in populations at increased risk.

Reference:

US Preventive Services Task Force. Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2023;329(17):1487–1494. doi:10.1001/jama.2023.4899