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Factors Associated With Tuberculin Skin Test Positivity Prevalence in U.S. Medical Laboratory Microbiologists
Prior research has indicated that healthcare personnel (HCP) who work in areas where Mycobacterium tuberculosis poses an occupational hazard are at high risk of tuberculin skin test (TST) positivity and subsequent conversion to active TB. U.S. medical laboratory microbiologists confront similar hazards but have not been studied outside of the HCP aggregate. A gap in the current literature remains regarding prevalence and risk factors of self-reported lifetime TST positivity among this subpopulation.
Methods:
This cross-sectional quantitative study included responses of 1,628 eligible participants from a cohort of American Society for Clinical Pathology (ASCP) medical laboratory microbiologists (N = 4,335). A researcher-designed (and pilot tested) self-administered questionnaire was comprised of demographic questions and Part A of the Brief Medication Questionnaire (Svarstad et al., 1999). Statistical procedures were performed using Epi Info™ Version 3.5.3.
Results:
Multivariate analysis identified factors associated with TST history in terms of predictor variables of history of bacille Calmette-Guérin (BCG) immunization, place of birth, and years of laboratory experience and outcomes of lifetime TST positivity, preventive treatment noninitiation, and barriers to treatment adherence (presence of medication side-effect barriers). Prevalence of positive TSTs was 17.0%; preventive treatment noninitiation 9.8%. TST positivity was more than double among the older (≥ 36 year) population. Multivariate analysis identified BCG (OR, 9.21; CI95, 5.26-16.13) and foreign birth (OR, 3.35; CI95, 1.97-5.72), age, nonoccupational exposure, history of TB, mycobacteriology work, and lab work outside of microbiology as predictors of a positive TST; foreign birth (OR 4.63; CI95, 1.44-14.90) was a predictor of treatment noninitiation. ‘Years of experience’ (≥ 21 years) was not identified as a predictor; no risk factors were found associated with barriers to treatment.
Conclusions:
These results demonstrate U.S. medical microbiologists continue to be at risk for developing LTBI and active TB; self-reported survey data is useful in determining a baseline. Results enhance positive social change by helping inform recommendations in the global fight to stop spread of TB.
Learning Areas:
EpidemiologyOccupational health and safety
Other professions or practice related to public health
Learning Objectives:
Describe prevalence outcomes of self-reported lifetime TST positivity, preventive treatment noninitiation, and barriers to treatment adherence -- presence of medication side-effect barriers as measured by the Brief Medication Questionnaire (Svarstad et al., 1999) among the U.S. American Society for Clinical Pathology (ASCP) membership reported to work in the area “Microbiology/Mycology/Parasitology/Virology” and acknowledging ever having had a positive tuberculin skin test and initiating preventive TB treatment.
Assess the association of history of BCG immunization, place of birth (U.S. or foreign), and years of laboratory experience with self-reported lifetime tuberculin skin test (TST) positivity.
Assess the association of history of BCG immunization, place of birth (U.S. or foreign), and years of laboratory experience with preventive treatment noninitiation among those individuals prescribed treatment for a positive tuberculin skin test.
Assess the association of history of BCG immunization, place of birth (U.S. or foreign), and years of laboratory experience with barriers to treatment adherence (medication side effects) among those initiating preventive treatment for a positive tuberculin skin test.
Keyword(s): Epidemiology, Tuberculosis
Qualified on the content I am responsible for because: I was the principal researcher involved in this researcher-designed self-administered questionnaire study. This research culminated in the dissertation and subsequent conferral of the degree of PhD. Among my scientific interests as a medical laboratorian have been the evaluation, performance, verification, and validation of microbiology test methods intended to assist hospital infection control and occupational health experts who use surveillance methods in the fight to stop the spread of TB among healthcare personnel.
Any relevant financial relationships? Yes
| Name of Organization | Clinical/Research Area | Type of relationship |
|---|---|---|
| ASCP | Lab Certification | Certified by the subject group, ASCP |
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.