Self-assessment of tuberculin skin test reactions by drug users with or at risk for human immunodeficiency virus infection

Marc N. Gourevitch, R. Teeter, E. E. Schoenbaum, R. S. Klein

Research output: Contribution to journalArticle


SETTING: Self-assessment of tuberculin test results, if accurate, could enhance tuberculosis screening efforts by reducing the need for follow-up visits for skin test reading. We investigated tuberculin test self-assessment in a longitudinal study of tuberculosis infection among drug users. OBJECTIVE: To determine the accuracy of tuberculin reaction self-assessment by drug users at high risk for tuberculosis infection. DESIGN: Two readings were compared of the same skin test, performed 48-72 hours after placement: 1) self-assessment using a simple yes-no approach to induration, versus 2) trained examiner reading. Self-assessments were performed immediately prior to trained examiner readings. RESULTS: Participants were 137 human immunodeficiency virus (HIV) seropositive and 344 HIV-seronegative current and former drug users. Ten per cent (35/344) of reactions read by participants as 'flat' were read by trained examiners as ≥5 mm (54% of which were ≥10 mm). Twenty-three per cent (19/82) of reactions read by trained examiners as ≥10 mm and 32% (35/110) of reactions read by trained examiners as being ≥5 mm were self-read by participants as 'flat'. Sensitivity (0.68) and specificity (0.83) of self-read tuberculin reactions were sub-optimal. Inter-reader reliability was poorer between participants and trained examiners than between trained examiners. CONCLUSION: Self-assessments of tuberculin skin test responses by drug users with or at risk for HIV infection are not reliable.

Original languageEnglish (US)
Pages (from-to)321-325
Number of pages5
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number4
StatePublished - Apr 1999



  • Drug users
  • HIV
  • PPD
  • Self-assessment
  • Tuberculin

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

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