Self-assessment of tuberculin skin test reactions by drug users with or at risk for human immunodeficiency virus infection.
METHODS
Self-assessment of tuberculin test results, if accurate, could enhance tuberculosis screening efforts by reducing the need for follow-up visits for skin test reading. We investigated tuberculin test self-assessment in a longitudinal study of tuberculosis infection among drug users.


OBJECTIVE
To determine the accuracy of tuberculin reaction self-assessment by drug users at high risk for tuberculosis infection.


METHODS
Two readings were compared of the same skin test, performed 48-72 hours after placement: 1) self-assessment using a simple yes-no approach to induration, versus 2) trained examiner reading. Self-assessments were performed immediately prior to trained examiner readings.


RESULTS
Participants were 137 human immunodeficiency virus (HIV) seropositive and 344 HIV-seronegative current and former drug users. Ten per cent (35/344) of reactions read by participants as 'flat' were read by trained examiners as > or =5 mm (54% of which were > or =10 mm). Twenty-three per cent (19/82) of reactions read by trained examiners as > or =10 mm and 32% (35/110) of reactions read by trained examiners as being > or =5 mm were self-read by participants as 'flat'. Sensitivity (0.68) and specificity (0.83) of self-read tuberculin reactions were sub-optimal. Inter-reader reliability was poorer between participants and trained examiners than between trained examiners.


CONCLUSIONS
Self-assessments of tuberculin skin test responses by drug users with or at risk for HIV infection are not reliable.
Gourevitch
M N
MN
Department of Epidemiology and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA. mgourevi@montefiore.org
Teeter
R
R
Schoenbaum
E E
EE
Klein
R S
RS
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005260:Female; D006679:HIV Seropositivity; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015203:Reproducibility of Results; D016353:Self-Examination; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D019966:Substance-Related Disorders; D014374:Tuberculin Test / Q000592:standards*; D014376:Tuberculosis / Q000517:prevention & control*