Abstract

Health care workers (HCWs) are at increased risk of latent tuberculosis infection (LTBI) and TB disease. We conducted an updated systematic review of the prevalence and incidence of LTBI in HCWs in low and middle-income countries (LMICs), associated factors, and infection control practices. We searched Medline, Embase, and Web of Science (01 January 2005–20 June 2017) for studies published in any language. We obtained pooled estimates using random effects methods, and investigated heterogeneity using meta-regression. Included were 85 studies (32 630 subjects) from 26 LMICs. Prevalence of positive tuberculin skin test (TST) was 14–98% (mean 49%); of Interferon-gamma release assays (IGRA) 9–86% (mean 39%). Countries with TB incidence ≥300/100 000 had the highest prevalence (TST: pooled estimate 55%, 95% CI 41–69%; IGRA: 56%, 39–73%). Annual incidence, estimated from TST, was 1–38% (mean 17%); from IGRA 10–30% (mean 18%). The prevalence and incidence of a positive test was associated with years of work, work location, TB contact, and job category. Only fifteen studies reported on infection control measures in health care facilities, with limited implementation. HCWs in LMICs in high TB incidence settings remain at increased risk of acquiring LTBI. There is an urgent need for robust implementation of infection control measures.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Apriani has nothing to disclose.

Conflict of interest: Dr. McAllister has nothing to disclose.

Conflict of interest: Dr. Sharples has nothing to disclose.

Conflict of interest: Dr. Alisjahbana has nothing to disclose.

Conflict of interest: Dr. Ruslami has nothing to disclose.

Conflict of interest: Dr. Hill has nothing to disclose.

Conflict of interest: Dr. Menzies has nothing to disclose.