Defining an intermediate category of tuberculin skin test: A mixture model analysis of two high-risk populations from Kampala, Uganda

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dc.contributor.authorWoldu, Henok G.
dc.contributor.authorZalwango, Sarah
dc.contributor.authorMartinez, Leonardo
dc.contributor.authorCastellanos, Maria Eugenia
dc.contributor.authorKakaire, Robert
dc.contributor.authorSekandi, Juliet N.
dc.contributor.authorKiwanuka, Noah
dc.contributor.authorWhalen, Christopher C.
dc.date.accessioned2021-12-09T13:29:41Z
dc.date.available2021-12-09T13:29:41Z
dc.date.issued2021
dc.description.abstractOne principle of tuberculosis control is to prevent the development of tuberculosis disease by treating individuals with latent tuberculosis infection. The diagnosis of latent infection using the tuberculin skin test is not straightforward because of concerns about immunologic cross reactivity with the Bacille Calmette-Guerin (BCG) vaccine and environmental mycobacteria. To parse the effects of BCG vaccine and environmental mycobacteria on the tuberculin skin test, we estimated the frequency distribution of skin test results in two divisions of Kampala, Uganda, ten years apart. We then used mixture models to estimate parameters for underlying distributions and defined clinically meaningful criteria for latent infection, including an indeterminate category. Using percentiles of two underlying normal distributions, we defined two skin test readings to demarcate three ranges. Values of 10 mm or greater contained 90% of individuals with latent infection; values less than 7.2 mm contained 80% of individuals without infection. Contacts with values between 7.2 and 10 mm fell into an indeterminate zone where it was not possible to assign infection. We conclude that systematic tuberculin skin test surveys within populations at risk, combined with mixture model analysis, may be a reproducible, evidence-based approach to define meaningful criteria for latent tuberculosis infection.en_US
dc.identifier.citationWoldu HG, Zalwango S, Martinez L, Castellanos ME, Kakaire R, Sekandi JN, et al. (2021) Defining an intermediate category of tuberculin skin test: A mixture model analysis of two high-risk populations from Kampala, Uganda. PLoS ONE 16(1): e0245328. https://doi.org/ 10.1371/journal.pone.0245328en_US
dc.identifier.urihttps://doi.org/ 10.1371/journal.pone.0245328
dc.identifier.urihttps://nru.uncst.go.ug/xmlui/handle/123456789/227
dc.language.isoenen_US
dc.publisherCreative Commons Attribution Licenseen_US
dc.subjectTuberculin skinen_US
dc.subjectPopulationsen_US
dc.subjectUgandaen_US
dc.titleDefining an intermediate category of tuberculin skin test: A mixture model analysis of two high-risk populations from Kampala, Ugandaen_US
dc.typeArticleen_US
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