title: The Prevalence and Incidence of Latent Tuberculosis Infection and Its Associated Factors among Village Doctors in China.
abstract: BACKGROUND
  China is a high tuberculosis (TB) burden country. More than half of acute TB cases first seek medical care in village doctors' clinics or community health centers. Despite being responsible for patient referral and management, village doctors are not systematically evaluated for TB infection or disease. We assessed prevalence and incidence of latent TB infection (LTBI) among village doctors in China.
  
  
  RESULTS
  A longitudinal study was conducted in Inner Mongolia Autonomous Region. We administered a questionnaire on demographics and risk factors for TB exposure and disease; Tuberculin skin testing (TST) and QuantiFERON-TB Gold in-tube assay (QFT-GIT) was conducted at baseline and repeated 12 months later. We used a logistic regression model to calculate adjusted odds ratios (ORs) for risk factors for TST and QFT-GIT prevalence and incidence. At the time of follow up, 19.5% of the 880 participating village doctors had a positive TST and 46.0% had a positive QFT-GIT result. Factors associated with TST prevalence included having a BCG scar (OR = 1.45, 95%CI 1.03-2.04) and smoking (OR = 1.69, 95%CI 1.17-2.44). Risk factors associated with QFT-GIT prevalence included being male (OR = 2.17, 95%CI 1.63-2.89), below college education (OR=1.42, 95%CI 1.01-1.97), and working for ≥25 years as a village doctor (OR = 1.64, 95%CI 1.12-2.39). The annual incidence of LTBI was 11.4% by TST and 19.1% by QFT-GIT. QFT-GIT conversion was associated with spending 15 minutes or more per patient on average (OR = 2.62, 95%CI 1.39-4.97) and having BCG scar (OR = 0.53, 95%CI 0.28-1.00).
  
  
  CONCLUSIONS
  Prevalence and incidence of LTBI among Chinese village doctors is high. TB infection control measures should be strengthened among village doctors and at village healthcare settings.
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Guangxue
authors.initials: G
authors.lastname: He
authors.affiliation: Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention Atlanta, Georgia, United States of America.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Zhao
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Lixia
authors.initials: L
authors.lastname: Wang
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Shiming
authors.initials: S
authors.lastname: Cheng
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Guo
authors.affiliation: Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention Atlanta, Georgia, United States of America.
authors.forename: John D
authors.initials: JD
authors.lastname: Klena
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Haiying
authors.initials: H
authors.lastname: Fan
authors.affiliation: Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China.
authors.forename: Fangfang
authors.initials: F
authors.lastname: Gao
authors.affiliation: Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Gao
authors.affiliation: Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China.
authors.forename: Guoxin
authors.initials: G
authors.lastname: Han
authors.affiliation: Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China.
authors.forename: Liping
authors.initials: L
authors.lastname: Ren
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Yudan
authors.initials: Y
authors.lastname: Song
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Yongchao
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Mengjie
authors.initials: M
authors.lastname: Geng
authors.affiliation: The Tongzhou Maternal & Child Health Hospital, Beijing, China.
authors.forename: Yueyun
authors.initials: Y
authors.lastname: Hou
authors.affiliation: Ulanqab Center for Tuberculosis Control and Prevention, Jining, China.
authors.forename: Guoming
authors.initials: G
authors.lastname: He
authors.affiliation: Ulanqab Center for Tuberculosis Control and Prevention, Jining, China.
authors.forename: Jianbo
authors.initials: J
authors.lastname: Li
authors.affiliation: Ulanqab Center for Tuberculosis Control and Prevention, Jining, China.
authors.forename: Shufang
authors.initials: S
authors.lastname: Guo
authors.affiliation: Ulanqab Center for Tuberculosis Control and Prevention, Jining, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.affiliation: the Bayannur for Tuberculosis Control and Prevention, Bayannur, China.
authors.forename: Daiqin
authors.initials: D
authors.lastname: Yan
authors.affiliation: the Bayannur for Tuberculosis Control and Prevention, Bayannur, China.
authors.forename: Yali
authors.initials: Y
authors.lastname: Wang
authors.affiliation: the Bayannur for Tuberculosis Control and Prevention, Bayannur, China.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Gao
authors.affiliation: Linhe District Center for Disease Control and Prevention, Bayannur, China.
authors.forename: Jing
authors.initials: J
authors.lastname: An
authors.affiliation: Linhe District Center for Disease Control and Prevention, Bayannur, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Duan
authors.affiliation: Hanggin Rear Banner Center for Disease Control and Prevention, Bayannur, China.
authors.forename: Chunru
authors.initials: C
authors.lastname: Wu
authors.affiliation: Hanggin Rear Banner Center for Disease Control and Prevention, Bayannur, China.
authors.forename: Fengming
authors.initials: F
authors.lastname: Duan
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Dongmei
authors.initials: D
authors.lastname: Hu
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Lu
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Yanlin
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention Atlanta, Georgia, United States of America.
authors.forename: Carol Y
authors.initials: CY
authors.lastname: Rao
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000328:Adult; D002681:China; D003150:Community Health Workers; D005260:Female; D006801:Humans; D015994:Incidence; D059425:Interferon-gamma Release Tests; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D014374:Tuberculin Test; D055815:Young Adult