Abstract
Background
Antigen-based skin tests (TBST) have been developed for detecting Mycobacterium tuberculosis (TB) infection (TBI). TBST may have comparable sensitivity and specificity to Interferon Gamma Release Assays (IGRA), the gold standard in TBI testing. However, they are portable and low cost, and may be better suited for use in large scale screening programmes and in resource-limited settings. To date, there is limited evidence on stakeholder values and preferences, and the acceptability, feasibility, and health equity impacts of TBST relative to existing TBI tests.
Methods
We explored end-user values and preferences, and perspectives on the acceptability, feasibility, and health equity impacts of TBST compared to IGRA and tuberculin skin tests (TST). 20 semi-structured interviews were conducted with TB healthcare consumers and providers from low-middle and high-income countries between Sept 07, 2021 and Nov 01, 2021. Data were transcribed verbatim and coded by two independent raters using inductive thematic analysis.
Results
Seven consumers and 13 providers of TB healthcare were interviewed from 11 low-middle and 9 high-income countries. Healthcare consumers and providers shared similar values and preferences towards TBI tests. Stakeholders valued TBI test accuracy, convenience, cost, patient experience, and resource requirements. Overall, TBST were viewed as more acceptable and equally feasible to TST, with greater health equity benefits from improved sensitivity and specificity. TBST were generally viewed to be less acceptable than IGRA due to some undesirable aspects of the patient experience (eg requires two patient visits, stigma and discomfort from the arm welt). TBST were viewed as more feasible than IGRA in resource-limited settings due to their portability and low cost. However, TBST are unlikely to replace IGRA in high-resource settings where the resourcing is already in place to support IGRA use.
Conclusions
TBST may be a more accurate alternative to TST that could be used in large scale screening programmes and in resource-limited healthcare settings. IGRA are likely to remain the preferred TBI test in high-resource healthcare settings as they have comparable sensitivity and specificity, and the resourcing is already in place for IGRA use. These findings may inform decision-making on TBI tests in global public healthcare.