title: Two-step tuberculin skin testing in drug users.
abstract: To assess the utility of booster testing and to identify factors associated with a positive booster test, two-step tuberculin testing was performed in drug users recruited from methadone treatment. Participants also received a standardized interview on demographics and testing for HIV and CD4+ lymphocyte count. Of 619 enrollees completing the protocol, 174 (28%) had a positive PPD and 24 of the remaining 445 (5%) had a positive booster test. On multivariate analysis, boosting was associated with older age (adjusted odds ratio [ORadj] 2.38/decade, 95% confidence interval [CI] 1.34-4.22), history of using crack cocaine (ORadj 2.61, 95% CI 1.10-6.18) and a history of working as a home health aide (ORadj 4.23, 95% CI 1.39-12.86). Two-step tuberculin skin testing increased the proportion of participants with latent tuberculosis infection from 22% to 25%. Given the effectiveness of chemoprophylaxis, booster testing should be considered when drug users are screened for tuberculosis infection.
authors.affiliation: Department of Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ 07101, USA. swaminsh@umdnj.edu
authors.forename: Shobha
authors.initials: S
authors.lastname: Swaminathan
authors.forename: Ellie E
authors.initials: EE
authors.lastname: Schoenbaum
authors.forename: Robert S
authors.initials: RS
authors.lastname: Klein
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Howard
authors.forename: Yungtai
authors.initials: Y
authors.lastname: Lo
authors.forename: Marc N
authors.initials: MN
authors.lastname: Gourevitch
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology* / Q000534:rehabilitation; D018791:CD4 Lymphocyte Count; D015897:Comorbidity; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D009519:New York City; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D014374:Tuberculin Test / Q000379:methods*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D009294:Narcotics; D008691:Methadone