Prevalence of tuberculosis infection in healthcare workers of the public hospital network in Medellin, Colombia: a Bayesian approach

A latent tuberculosis infection (LTBI) prevalence survey was conducted using tuberculin skin test (TST) and Quantiferon test (QFT) in 1218 healthcare workers (HCWs) in Medellin, Colombia. In order to improve the prevalence estimates, a latent class model was built using a Bayesian approach with informative priors on the sensitivity and specificity of the TST. The proportion of concordant results (TST+, QFT+) was 41% and the discordant results contributed 27%. The marginal estimate of the prevalence P(LTBI+) was 62.1% [95% credible interval (CrI) 53.0-68.2]. The probability of LTBI+ given positive results for both tests was 99.6% (95% CrI 98.1-99.9). Sensitivity was 88.5 for TST and 74.3 for QFT, and specificity was 87.8 for TST and 97.6 for QFT. A high LTBI prevalence was found in HCWs with time-accumulated exposure in hospitals that lack control plans. In a context of intermediate tuberculosis (TB) incidence it is recommended to use only one test (either QFT or TST) in prevalence surveys or as pre-employment tests. Results will be useful to help implement TB infection control plans in hospitals where HCWs may be repeatedly exposed to unnoticed TB patients, and to inform the design of TB control policies.