A simple protocol for tuberculin skin test reading certification

Area of Science:

• Public Health
• Infectious Disease Management
• Medical Education

Background:

• Latent tuberculosis infection (LTBI) treatment is crucial for tuberculosis elimination.
• Healthcare professional certification for reading tuberculin skin tests (TST) presents a significant barrier in LTBI care.
• Effective and accessible training methods for TST reading are needed.

Purpose of the Study:

• To propose and evaluate a simple training protocol for healthcare workers on reading TST indurations.
• To assess the accuracy and effectiveness of a novel training method using simulated blebs.
• To improve the cascade of care for LTBI by addressing training barriers.

Main Methods:

• A 2-hour theoretical course followed by a practical session using saline blebs injected into sausages and volunteers.
• Trainees (primary care workers) read simulated blebs and actual TST indurations.
• Interobserver agreement analyzed using Bland-Altman test; accuracy assessed at 5mm and 10mm cut-offs.

Main Results:

• High agreement observed in TST reading between trainees (0.07mm average bias).
• Sensitivity reached 100% at the 5mm cut-off and 87.3% at the 10mm cut-off.
• No significant effect of the number of readings on accuracy was found.

Conclusions:

• A straightforward training protocol utilizing saline bleb simulations is adequate for accurate TST reading.
• This training method is safer, easier, and more accessible than traditional approaches.
• The protocol effectively equips primary care workers to manage LTBI diagnosis, reducing barriers to care.