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USPSTF 2023: Screening recommended for latent tuberculosis infection in adults at increased risk (B recommendation)
Clinical Question
Should primary care clinicians screen asymptomatic adults for latent tuberculosis infection?
Bottom line
The USPSTF continues to conclude that current evidence is sufficient to support an overall moderate net benefit in screening for LTBI in asymptomatic adults, 18 years or older, who are at increased risk for tuberculosis infection (B recommendation). Persons at increased risk for LTBI include those who were born in (or are former residents of) countries with high tuberculosis prevalence, and persons who live in (or have lived in) high-risk settings, including homeless shelters or correctional facilities. This update is consistent with the 2016 USPSTF review. 2c
Reference
Study design: Practice guideline
Funding: Government
Setting: Various (guideline)
Synopsis
The US Preventive Services Task Force (USPSTF) found no studies that directly evaluated the benefits and harms of screening versus no screening for latent tuberculosis infection (LTBI). Current screening tests, including the tuberculin skin test and the interferon-gamma release assay, are moderately sensitive and highly specific. Treatment of LTBI reduces the risk of progression to active tuberculosis and the magnitude of harms from treatment is small, with the primary harm being hepatotoxicity (mainly from isoniazid). The task force makes no recommendation on the frequency of screening, and instead recommends that clinicians consult with their own local or state health departments about population risk in their communities. The Centers for Disease Control, the Infectious Diseases Society of America, and the American Academy of Family Physicians all make similar recommendations.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Impact assessment
Excellent
SCREENING LATENT TB
GOOD TO KNOW