Tuberculin skin testing and QuantiFERON™-TB Gold Plus positivity among household contacts in Vietnam

SETTING: TB infection (TBI) is diagnosed using the technique-dependent tuberculin skin test (TST) or costly, more accurate interferon-gamma release assays. The TST (10 mm) threshold was indicated by previous research among household contacts in Vietnam, but routine implementation with a different tuberculin reagent showed unexpectedly low TST positivity.OBJECTIVE: TST (5 mm and 10 mm) results were compared to QuantiFERON™-TB Gold Plus (QFT) results in household contacts during community campaigns in 2020 and 2021.DESIGN: This was a cross-sectional multi-center implementation study.RESULTS: Among 1,330 household contacts in 2020, we found a TBI prevalence of 38.6% (QFT), similar to TST 5 mm (37.4%) and higher than TST 10 mm (13.1%). QFT+/TST+ was higher for TST 5 mm (20.7%) than TST 10 mm (9.4%). QFT was not discordant with TST 5 mm (McNemar's test = 0.6, P = 0.5) but was discordant with TST 10 mm (McNemar's test = 263.9, P < 0.01). Older age and Southern region increased odds for positive TST 5 mm and QFT with weaker associations for TST 10 mm. Agreement and discordance were similar in 2021 for 1,158 household contacts.CONCLUSION: Tuberculin reagents affect TST positivity rates. High TB burden countries should monitor reliability of TBI diagnosis, including tuberculin potency, cold chain, and TST technique to optimize eligibility for TB preventive treatment.