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Free Content Two-step tuberculin skin testing of injection drug users recruited from community-based settings

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Setting: Cross-sectional study of drug users recruited from street-based settings in four US cities: Denver, Portland, Oakland and San Francisco.

Objective: To evaluate responses to two-step tuberculin skin testing among HIV-positive and HIV-negative injection drug users.

Design: Subjects were recruited from existing studies of HIV and risk behaviors for tuberculin skin testing. Those with a negative initial tuberculin test were referred for a second skin test 1–3 weeks later. A positive tuberculin test was defined as ≥10 mm, or ≥5 mm if the subject was HIV-positive.

Results: Of 997 persons receiving an initial tuberculin test, 13% had a positive response. Of 644 persons receiving a second tuberculin test, 8% had a positive response, with rates as high as 14% among those from Oakland and 12% among African Americans. HIV-positive subjects were less likely to have skin test responses ≥10 mm on the initial test (P = 0.03), or increases between the initial and second test of ≥10 mm (P = 0.06).

Conclusion: Boosting occurred in both HIV-positive and HIV-negative injection drug users. Two-step testing should be considered for this population, particularly those on whom repeat tuberculin testing will be performed.
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Keywords: HIV; booster effect; injection drug users; tuberculin testing; two-step testing

Document Type: Regular Paper

Affiliations: 1: Division of Epidemiology, University of Minnesota, Minneapolis, Minnesota, USA 2: Urban Health Study, University of California, San Francisco, California, USA 3: Project Safe, University of Colorado, Denver, Colorado, USA 4: HIV Program, Oregon Health Division, Portland, Oregon, USA 5: Multnomah County Health Department, Portland, Oregon, USA

Publication date: 1997-04-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

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