Healthcare workers and students who work in high tuberculosis incidence settings in low and middle-income countries remain at increased risk of acquiring latent tuberculosis infection (LTBI), according to a new study published in the European Respiratory Journal.
Researchers conducted a systematic review of literature published between 2005-2017 to assess the prevalence and incidence of LTBI in healthcare workers and students in low and middle-income countries. The research team obtained pooled estimates using random effects methods and investigated heterogeneity using meta-regression.
The analysis of 85 original articles found that nearly 50% of healthcare workers and 32% of healthcare students were found to have a positive tuberculin skin test, while 39% and 25% respectively had a positive IGRA (Interferon Gamma Release Assay) test, indicating active or latent TB.
Data also showed that healthcare workers from countries with an annual TB incidence of more than 300/100,000 had the highest prevalence of LTBI, with more than half of healthcare workers found to test positive using the tuberculin skin test or the IGRA test.
Additionally, the annual incidence of LTBI was 17% in healthcare workers and 5% in healthcare students when estimated from serial tuberculin skin test, and at 18% and 8% respectively, when estimated with IGRA.
The study states that only 15 of the studies included in the review reported on infection control measures in healthcare facilities, and of those studies, all reported that none of the healthcare facilities assessed implemented a full program of TB infection control. The researchers note that five of the 15 studies reported on TB infection control policies, and just one reported infection control training.
The study concludes that the data shows that healthcare workers in low and middle-income countries continue to have unacceptably high prevalence and incidence of TB infection, and that basic control measures are rarely implemented.
The authors recommend that TB programs in high TB incidence countries must prioritise implementation of infection control measures in healthcare facilities to improve protection for healthcare workers and students.