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We explored alternative conversion definitions to assist the interpretation of serial QFT results and estimate incidence of TB infection in a large cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used QFT serial results from TB household contacts aged \u226515\u2009years, collected at baseline and during two follow-up visits (2006\u20132011) as part of a cohort study in 24 communities in Zambia and South Africa (SA). Conversion rates using the manufacturers\u2019 definition (interferon-gamma (IFN-g) &lt;\u20090.35 to \u22650.35, \u2018def1\u2019) were compared with stricter definitions (IFN-g\u2009&lt;\u20090.2 to \u22650.7\u2009IU\/ml, \u2018def2\u2019; IFN-g\u2009&lt;\u20090.2 to \u22651.05\u2009IU\/ml, \u2018def3\u2019; IFN-g\u2009&lt;\u20090.2 to \u22651.4\u2009IU\/ml, \u2018def4\u2019). Poisson regression was used for analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One thousand three hundred sixty-five individuals in Zambia and 822 in SA had QFT results available. Among HIV-negative individuals, the QFT conversion rate was 27.4 per 100 person-years (CI:22.9\u201332.6) using def1, 19.0 using def2 (CI:15.2\u201323.7), 14.7 using def3 (CI:11.5\u201318.8), and 12.0 using def4 (CI:9.2\u201315.7). Relative differences across def1-def4 were similar in Zambia and SA. Using def1, conversion was less likely if HIV positive not on antiretroviral treatment compared to HIV negative (aRR\u2009=\u20090.7, 95%CI\u2009=\u20090.4\u20130.9), in analysis including both countries. The same direction of associations were found using def 2\u20134.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>High conversion rates were found even with the strictest definition, indicating high incidence of TB infection among household contacts of TB patients in these communities. The trade-off between sensitivity and specificity using different thresholds of QFT conversion remains unknown due to the absence of a reference standard. However, we identified boundaries within which an appropriate definition might fall, and our strictest definition plausibly has high specificity.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12879-020-05483-9","type":"journal-article","created":{"date-parts":[[2020,10,15]],"date-time":"2020-10-15T09:02:47Z","timestamp":1602752567000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Interpretation of serial interferon-gamma test results to measure new tuberculosis infection among household contacts in Zambia and South Africa"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7295-3247","authenticated-orcid":false,"given":"Rosa","family":"Sloot","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kwame","family":"Shanaube","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mareli","family":"Claassens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lily","family":"Telisinghe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ab","family":"Schaap","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Godfrey-Faussett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"Ayles","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sian","family":"Floyd","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,10,15]]},"reference":[{"key":"5483_CR1","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/S1473-3099(11)70210-9","volume":"12","author":"MX Rangaka","year":"2012","unstructured":"Rangaka MX, Wilkinson KA, Glynn JR, Ling D, Menzies D, Mwansa-Kambafwile J, et al. 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Governmental approval for the trial was obtained in both countries. All individuals involved in the study gave written informed consent. A parent or guardian provided informed consent for participants under 16\u2009years old.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"760"}}