{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:54:41Z","timestamp":1785779681290,"version":"3.56.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1116632"],"award-info":[{"award-number":["OPP1116632"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1137034"],"award-info":[{"award-number":["OPP1137034"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100015093","name":"Strategic Health Innovation Partnerships","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100015093","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001322","name":"Unit of the South African Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016962","name":"South African Department of Science and Technology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016962","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Identifying risk factors for Mycobacterium tuberculosis (Mtb) sensitization (defined as interferon-gamma release assays [IGRA]-positive) and progression to tuberculosis (TB) disease is critical to guide targeted prevention strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from a prospective cohort of adults (18\u201360 years) without HIV, enrolled at five high-incidence South African sites. Participants underwent testing for Mtb sensitization and microbiologically confirmed TB at baseline, and during 15 months follow-up. Multivariable logistic and Cox regression models were used to assess factors associated with Mtb sensitization and TB progression. Sampling weights were applied to reflect the screened population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2912 participants with valid IGRA results, 63.4% (n = 1895) were Mtb-sensitized. Prevalent TB was detected in 1.81% (62\/1895) of Mtb-sensitized vs 0.62% (12\/1017) of Mtb-unsensitized individuals (P = .01). During follow-up of participants without prevalent TB, 2.01% (48\/1833) Mtb-sensitized and 0.53% (8\/1005) Mtb-unsensitized individuals developed TB (P = .01). Factors associated with Mtb sensitization included increasing age (adjusted odds ratio [aOR] = 1.02, 95% CI 1.01\u20131.03), male sex (aOR = 1.34, 95% CI 1.08\u20131.67), smoking (aOR = 1.31, 95% CI 1.05\u20131.64), prior TB (aOR = 2.20, 95% CI 1.40\u20133.47), and TB contact history (aOR = 1.40, 95% CI 1.08\u20131.83). Risk factors for progression to TB were Mtb sensitization (adjusted hazard ratio [aHR] = 3.05, 95% CI 1.14\u20138.18), smoking history (aHR = 2.34, 95% CI 1.03\u20135.31), and lower body mass index (BMI) (aHR = 0.89, 95% CI .82\u2013.97).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Mtb-sensitized individuals had a 3-fold higher risk of prevalent TB and progressing to TB compared to Mtb-unsensitized individuals. In high-prevalence settings, identifying individuals at greatest risk\u2014such as those recently infected, with a history of smoking, or low BMI\u2014could help refine TB prevention efforts and reduce community-level transmission.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiag100","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T20:52:54Z","timestamp":1771447974000},"page":"e180-e188","source":"Crossref","is-referenced-by-count":1,"title":["Risk Factors for Immunological Sensitization to\n                    <i>Mycobacterium tuberculosi<\/i>\n                    s and Progression to Incident TB Disease Among HIV-uninfected Adults in a High Burden Setting"],"prefix":"10.1093","volume":"234","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2030-0751","authenticated-orcid":false,"given":"Humphrey","family":"Mulenga","sequence":"first","affiliation":[{"name":"South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Department of Pathology, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4054-2766","authenticated-orcid":false,"given":"Simon C","family":"Mendelsohn","sequence":"additional","affiliation":[{"name":"South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Department of Pathology, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7627-2166","authenticated-orcid":false,"given":"Andrew","family":"Fiore-Gartland","sequence":"additional","affiliation":[{"name":"Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center , Seattle, Washington ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1883-0059","authenticated-orcid":false,"given":"Adam","family":"Penn-Nicholson","sequence":"additional","affiliation":[{"name":"South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Department of Pathology, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4526-8479","authenticated-orcid":false,"given":"Munyaradzi","family":"Musvosvi","sequence":"additional","affiliation":[{"name":"South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Department of Pathology, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7983-7203","authenticated-orcid":false,"given":"Mich\u00e8le","family":"Tameris","sequence":"additional","affiliation":[{"name":"South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Department of Pathology, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2487-125X","authenticated-orcid":false,"given":"Gerhard","family":"Walzl","sequence":"additional","affiliation":[{"name":"Division of Immunology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, DST\/NRF Centre of Excellence for Biomedical TB Research and SAMRC Centre for TB Research, Stellenbosch University , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8874-6661","authenticated-orcid":false,"given":"Kogieleum","family":"Naidoo","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA)- SAMRC- HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4269-3699","authenticated-orcid":false,"given":"Gavin","family":"Churchyard","sequence":"additional","affiliation":[{"name":"The Aurum Institute , Head office, Johannesburg, Gauteng ,","place":["South Africa"]},{"name":"School of Public Health, University of Witwatersrand , Johannesburg ,","place":["South Africa"]},{"name":"Department of Medicine, Vanderbilt University , Nashville, Tennessee 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