Article

High prevalence of latent tuberculosis infection among injection drug users in Tijuana, Mexico

University of California San Diego, School of Medicine, San Diego, California, USA.
The International Journal of Tuberculosis and Lung Disease (Impact Factor: 2.32). 06/2009; 13(5):626-32.
Source: PubMed

ABSTRACT

We studied prevalence and correlates of latent tuberculosis infection (LTBI) among injection drug users (IDUs) in Tijuana, Mexico, where tuberculosis (TB) is endemic.
IDUs aged > or =18 years were recruited via respondent-driven sampling (RDS) and underwent standardized interviews, human immunodeficiency virus (HIV) antibody testing and LTBI screening using Quanti-FERON((R))-TB Gold In-Tube, a whole-blood interferon-gamma release assay (IGRA). LTBI prevalence was estimated and correlates were identified using RDS-weighted logistic regression.
Of 1020 IDUs, 681 (67%) tested IGRA-positive and 44 (4%) tested HIV-positive. Mean age was 37 years, 88% were male and 98% were Mexican-born. IGRA positivity was associated with recruitment nearest the US border (aOR 1.64, 95%CI 1.09-2.48), increasing years of injection (aOR 1.20/5 years, 95%CI 1.07-1.34), and years lived in Tijuana (aOR 1.10/5 years, 95%CI 1.03-1.18). Speaking some English (aOR 0.38, 95%CI 0.25-0.57) and injecting most often at home in the past 6 months (aOR 0.68, 95%CI 0.45-0.99) were inversely associated with IGRA positivity.
Increased LTBI prevalence among IDUs in Tijuana appears to be associated with greater drug involvement. Given the high risk for HIV infection among Tijuana's IDUs, interventions are urgently needed to prevent HIV infection and treat LTBI among IDUs before these epidemics collide.

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    • "Whether a country is struggling to eliminate TB, and needs to invest additional resources to effectively provide those who are hardest to reach (see section: vulnerable populations), screening selected high-risk groups may be a key part of the response to tackle TB. In this regard, some studies have used IGRAS in Mexican population, but those studies have been focused in some risk groups such as injection drug users [76], migrant agricultural workers [77], PTB contacts [78,79], dairy farm and abattoir workers [80], and HIV-infected people [81,82]. Controversial results have emerged when comparing TST and IGRAS [83]. "

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    • "These sampling weights allowed us to adjust for participants' different social network sizes (i.e., different numbers of potential recruits) and homophily within recruitment dyads (i.e., the tendency of recruiters to recruit others similar to themselves), thereby minimizing the bias introduced by the sampling method. Although there is currently no consensus on appropriate regression modeling of RDS data (Johnston, Malekinejad, Kendall, Iuppa, & Rutherford, 2008), sampling weights are an increasingly accepted approach (Garfein et al., 2009; Jenness et al., 2011; Townsend et al., 2010; Wayal et al., 2011). To maximize statistical power, we imputed any missing data. "
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