{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T01:28:54Z","timestamp":1784942934283,"version":"3.55.0"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T00:00:00Z","timestamp":1710720000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020884","name":"QIAGEN","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020884","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002101","name":"Division of Health Sciences, University of Otago","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002101","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100015690","name":"Universitas Padjadjaran","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100015690","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>No gold standard diagnostic test exists for latent tuberculosis infection (LTBI). The intra-dermal tuberculin skin test (TST) has known limitations and Interferon-gamma release assays (IGRA) have been developed as an alternative. We aimed to assess agreement between IGRA and TST, and risk factors for test positivity, in Indonesian healthcare students.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Medical and nursing students starting their clinical training were screened using IGRA and TST. Agreement between the two tests was measured using Cohen\u2019s Kappa coefficient. Logistic regression was used to identify factors associated with test positivity.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of 266 students, 43 (16.2%) were IGRA positive and 85 (31.9%) TST positive. Agreement between the two tests was 74.7% (kappa 0.33, 95% CI 0.21\u20130.45, P&lt;0.0001). Students who had direct contact with family or friends with TB were less likely to be test positive using IGRA (AOR 0.18, 95% CI 0.05\u20130.64) and using TST (AOR 0.51, 95% CI 0.26\u20130.99).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Test positivity for LTBI was lower when measured by IGRA than by TST, with poor agreement between the two tests. Known close TB contact was unexpectedly negatively associated with positivity by either test. Longitudinal studies may be required to help determine the best test for LTBI in healthcare students in Indonesia.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0299874","type":"journal-article","created":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T17:30:28Z","timestamp":1710783028000},"page":"e0299874","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Tuberculin skin test and Interferon-gamma release assay agreement, and associated factors with latent tuberculosis infection, in medical and nursing students in Bandung, Indonesia"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9810-8711","authenticated-orcid":true,"given":"Lika","family":"Apriani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"McAllister","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrina","family":"Sharples","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isni Nurul","family":"Aini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanifah","family":"Nurhasanah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dwi Febni","family":"Ratnaningsih","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3923-9767","authenticated-orcid":true,"given":"Agnes Rengga","family":"Indrati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rovina","family":"Ruslami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bachti","family":"Alisjahbana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinout","family":"van Crevel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip C.","family":"Hill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,3,18]]},"reference":[{"key":"pone.0299874.ref001","volume-title":"Latent tuberculosis infection: Updated and consolidated guidelines for programmatic management","author":"World Health Organization","year":"2018"},{"issue":"3","key":"pone.0299874.ref002","doi-asserted-by":"crossref","first-page":"ofx137","DOI":"10.1093\/ofid\/ofx137","article-title":"Risk of Tuberculosis Infection and Disease for Health Care Workers: An Updated Meta-Analysis","volume":"4","author":"L Uden","year":"2017","journal-title":"Open Forum Infect Dis"},{"key":"pone.0299874.ref003","article-title":"Latent tuberculosis infection in health care workers in low and middle-income countries: an updated systematic review","author":"L Apriani","year":"2019","journal-title":"The European respiratory journal"},{"issue":"1","key":"pone.0299874.ref004","first-page":"53","article-title":"The WHO tuberculin test","volume":"34","author":"F Deck","year":"1964","journal-title":"Bull Int Union Tuberc"},{"issue":"2","key":"pone.0299874.ref005","first-page":"161","article-title":"A comparison in the United States of America of two tuberculins, PPD-S and RT 23","volume":"31","author":"GW Comstock","year":"1964","journal-title":"Bull World Health Organ"},{"issue":"11","key":"pone.0299874.ref006","first-page":"1192","article-title":"False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria?","volume":"10","author":"M Farhat","year":"2006","journal-title":"Int J Tuberc Lung Dis"},{"issue":"1","key":"pone.0299874.ref007","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1164\/ajrccm.159.1.9801120","article-title":"Interpretation of repeated tuberculin tests. 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Cohen","year":"1960","journal-title":"Educational and Psychological Measurement"},{"issue":"3","key":"pone.0299874.ref022","doi-asserted-by":"crossref","first-page":"276","DOI":"10.11613\/BM.2012.031","article-title":"Interrater reliability: the kappa statistic","volume":"22","author":"ML McHugh","year":"2012","journal-title":"Biochem Med (Zagreb)"},{"issue":"11","key":"pone.0299874.ref023","doi-asserted-by":"crossref","first-page":"853","DOI":"10.7196\/samj.7092","article-title":"Prevalence, risk factors and risk perception of tuberculosis infection among medical students and healthcare workers in Johannesburg, South Africa","volume":"103","author":"A van Rie","year":"2013","journal-title":"S Afr Med J"},{"key":"pone.0299874.ref024","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1186\/1756-0500-5-415","article-title":"Diagnosis of latent tuberculosis infection in healthy young adults in a country with high tuberculosis burden and BCG vaccination at birth","volume":"5","author":"AF Dagnew","year":"2012","journal-title":"BMC Res Notes"},{"issue":"7","key":"pone.0299874.ref025","doi-asserted-by":"crossref","first-page":"e0219131","DOI":"10.1371\/journal.pone.0219131","article-title":"High risk for latent tuberculosis infection among medical residents and nursing students in India","volume":"14","author":"A Kinikar","year":"2019","journal-title":"PLoS One"},{"issue":"4","key":"pone.0299874.ref026","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1177\/17571774211046887","article-title":"Mycobacterium tuberculosis infection and disease in healthcare workers in a tertiary referral hospital in Bandung, Indonesia","volume":"23","author":"L Apriani","year":"2022","journal-title":"Journal of Infection Prevention"},{"issue":"4","key":"pone.0299874.ref027","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.tube.2015.04.003","article-title":"Latent tuberculosis infection\u2014Revisiting and revising concepts","volume":"95","author":"P Salgame","year":"2015","journal-title":"Tuberculosis (Edinb)"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0299874","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T17:30:50Z","timestamp":1710783050000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0299874"}},"subtitle":[],"editor":[{"given":"Mao-Shui","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,3,18]]},"references-count":27,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0299874","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,18]]}}}