The World Health Organization recommends tuberculin skin
tests (TSTs) where feasible to identify individuals most likely to benefit from
isoniazid preventive therapy (IPT). The requirement for TST reading after 48-72
h by a trained nurse is a barrier to implementation and increases loss to
follow-up.
Patients with human immunodeficiency virus (HIV) infection
were recruited from a primary care clinic in South Africa and trained by a lay
counsellor to interpret their own TST. The TST was placed by a nurse, and the
patient was asked to return 2 days later with their self-reading result,
followed by blinded reading by a trained nurse (reference).
Of 227 patients, 210 returned for TST reading; 78%
interpreted their test correctly: those interpreting it as negative were more
likely to be correct (negative predictive value 93%) than those interpreting it
as positive (positive predictive value 42%); 10/36 (28%) positive TST results
were read as negative by the patient.
Patients with HIV in low-resource settings can be trained to
interpret their own TST. Those interpreting it as positive should return to the
clinic within 48-72 h for confirmatory reading and IPT initiation; those with a
negative interpretation can return at their next scheduled visit and initiate
IPT at that time if appropriate.
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By:
- 1Médecins Sans Frontières, Khayelitsha, South Africa.
- 2City of Cape Town Health Department, Khayelitsha, South Africa.
- 3Médecins Sans Frontières, Khayelitsha, South Africa; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
- 4Centre for Infectious Disease Epidemiology, Department of Infection and Population Health, University College London, London, UK.
- 5Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
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