Task Force Recommends Latent TB Infection Screening - AAFP News

May 22, 2023, News Staff — The U.S. Preventive Services Task Force recently issued an updated final recommendation to screen asymptomatic adults who are at increased risk for latent tuberculosis infection. The update clarifies information about diagnosis and testing, and links to resources.

Screening and Treatment

Although there is no direct test to diagnose latent infection with Mycobacterium tuberculosis, two types of screening tests for latent TB infection are available in the United States: the tuberculin skin test and the interferon-gamma release assay. Both are moderately sensitive and highly specific, and each has certain advantages and disadvantages.

For example, while the TST test is less invasive than the IGRA, it requires that patients return to the clinic or physician's office 48 to 72 hours after the test is administered to interpret the results, meaning planning for an additional visit. The IGRA test, meanwhile, can be performed in a single office visit, but it requires a venous blood sample that must be delivered to a laboratory for analysis within a specific timeframe (between 8 and 30 hours, depending on the version of the test).

Latent TB infection can be treated effectively with antibiotics. Preferred treatment regimens, according to the CDC and the National Tuberculosis Controllers Association, include rifampin (daily for 4 months), isoniazid plus rifapentine (once weekly for three months) and isoniazid plus rifampin (daily for three months) based on safety, effectiveness and high completion rates.

Responses, Resources and Research

In response to public comments on a draft of the recommendation statement, the task force added clarifying information indicating that clinical assessment, physical examination and diagnostic workup are necessary for diagnosis. The task force also clarified scenarios where IGRA testing could be preferable to the TST and added more guidance about screening and treatment to the Practice Considerations section.

In addition, the USPSTF provided links to 11 new resources, including

Due to several evidence gaps, the task force also called for studies to determine the accuracy of risk assessment tools in identifying which individuals are at increased risk for latent TB infection and who should receive screening; determine which populations should receive repeat screening and how frequently; and which screening strategies are more effective for specific patient populations.

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