Impact on USAF tuberculosis detection and control program given a low facility tuberculosis prevalence rate

Isoniazid prophylaxis is a major part of the U.S. Air Force tuberculosis (TB) screening program and is closely tied to the efforts to eliminate TB. If a facility has a low prevalence rate of TB and there is no sound epidemiological evidence to rule out a false-positive TB skin test, a higher threshold for what constitutes a positive reaction in a given population may be appropriate. Criteria for preventive treatment in Air Force Instruction 48-115, para 3.4.2 and 3.4.5, should be expanded to incorporate the positive- predictive rate of the tuberculin skin test as recommended by the Centers for Disease Control and Prevention.