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An Evaluation of the Latent Tuberculosis Control Program in the United States Military at Accession

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Technical Report

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Uniformed Services University Of The Health Sciences Bethesda United States

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Although the Centers for Disease Control and Prevention CDC recommend targeted testing for latent tuberculosis infection LTBI, the military has continued universal testing for all recruits. Furthermore, it has been suggested that the interferon-gamma release assays IGRAs may be more specific and cost-effective than the tuberculin skintest TST. This dissertation examines the impact of proposed changes in screening policy at accession, including both targeted testing and the use of IGRAs for screening. The epidemiology of tuberculosis TB in the US military is similar to the general population with an incidence that is low and declining. Risk factors for developing activeTB are similar to the general US population. Therefore, effective screening and treatment at time of accession is a critical element of the militarys TB control program. Targeted testing was evaluated in US Army recruits at Fort Jackson using a questionnaire, the TST, both commercially-available IGRAs. Prediction models were developed which demonstrated that targeted testing based on presence of four risk factors could eliminate 91 of testing with a sensitivity of 79 and specificity of 92.

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