Latent tuberculosis infection (LTBI) screening

USPSTF2023Grade B

Screen asymptomatic adults 18 and older at increased risk: persons born in or who lived in countries with high TB prevalence, and persons who live in or have lived in high-risk congregate settings (homeless shelters, correctional facilities). Test with TST or IGRA. No evidence on optimal screening interval; a reasonable approach ranges from one-time screening for those at low risk of future exposure to annual screening for those with continued exposure. Does not apply to symptomatic adults or to children.

ATS/IDSA/CDC2017Grade Strong recommendation, moderate-quality evidence

Age 5 and older, likely infected, at low or intermediate risk of progression, when testing is warranted: use an IGRA rather than a TST if BCG-vaccinated or unlikely to return for a TST reading (strong), and suggest IGRA for others (conditional). TST is acceptable if IGRA is unavailable, too costly, or burdensome. High progression risk: no preference. Under 5: suggest TST. Do not test low-risk people; if testing is required anyway, suggest confirming a positive with a second test (conditional).

CDC/NTCA2020Grade Strong (3HP, 4R); conditional (3HR)

Treat LTBI with a short-course rifamycin regimen, preferred over 6 to 9 months of isoniazid: 3HP, 12 weekly doses of isoniazid plus rifapentine (strong; adults and children over 2, including HIV as interactions allow); 4R, 4 months of daily rifampin (strong; HIV-negative); or 3HR, 3 months of daily isoniazid plus rifampin (conditional). Isoniazid for 6 or 9 months is the alternative.