Urine testing to monitor adherence to TB preventive therapy

• Published in: Journal of clinical epidemiology Vol. 55; no. 3; pp. 235 - 238
• Main Authors: Perry, Sharon, Hovell, Melbourne F., Blumberg, Elaine, Berg, Jill, Vera, Alicia, Sipan, Carol, Kelley, Norma, Moser, Kathleen, Catanzaro, Antonino, Friedman, Larry
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-2002; Elsevier
• Subjects: Adherence; Adolescent; Antitubercular Agents - therapeutic use; Antitubercular Agents - urine; Bacterial diseases; Biological and medical sciences; Female; Hispanic Americans; Human bacterial diseases; Humans; Infectious diseases; INH; Investigative techniques, diagnostic techniques (general aspects); Isoniazid - therapeutic use; Isoniazid - urine; Latent tuberculosis infection (LTBI); Male; Medical sciences; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Patient Compliance; Sensitivity and Specificity; Sensitivity/specificity; Tuberculosis - prevention & control; Tuberculosis and atypical mycobacterial infections; Urinary system; Validity of Arkansas urine test; Youth; United States; North America; America; Adherence; Youth; Validity of Arkansas urine test; INH; Sensitivity/specificity; Latent tuberculosis infection (LTBI); Human; Performance evaluation; Urine; Mycobacterial infection; Epidemiology; Infection; Prevention; Tuberculosis; Adolescent; Bacteriosis; Diagnosis; Technique; Public health
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/S0895-4356(01)00470-X

This study examined the validity of the Arkansas urine test. One hundred ninety-four adolescents submitted an unannounced urine specimen monthly (for 6 to 8 months). Duplicate specimens were blindly tested with high agreement (kappa >90%). Sensitivity and specificity were estimated. In 68% of test runs, adolescents recalled taking INH within 24 hr of specimen collection. For recall intervals of 24, 48, and 72 hr, sensitivity was 87, 85, and 83%, respectively. Females were less likely to test positive when INH was taken within the previous 24 hr (sensitivity 84 versus 92% males). Specificity was 57, 91, and 95% at 24, 48, and 72 hr, respectively. The Arkansas urine test was practical to use, and results correlated well with self-reported adherence to INH for treatment of latent tuberculosis infection (LTBI), over several months of follow-up. The test may be useful as part of an adherence-monitoring program when used in conjunction with self-reported measures.