Latent tuberculosis infection among hemodialysis patients in a national multi-governorate screening initiative in Egypt

Abstract Patients with end-stage renal disease receiving maintenance hemodialysis are at increased risk of developing active tuberculosis (TB) and are therefore, considered a priority population for latent tuberculosis infection (LTBI) screening and management. This study aimed to estimate the prevalence of LTBI and identify factors independently associated with QuantiFERON-TB Gold Plus (QFT-Plus) positivity among patients receiving maintenance hemodialysis in 13 selected governorates in Egypt. A retrospective registry-based cross-sectional study was conducted using records from the Egyptian Tuberculosis Health Initiative collected between November 2022 and December 2023 from designated screening facilities. Descriptive statistics were used to summarize the data, and between-group comparisons were performed using the Chi-square test and analysis of variance (ANOVA), as appropriate. Multivariable logistic regression and generalized linear mixed models (GLMMs) were applied to identify factors independently associated with QFT-Plus positivity. Geographic distribution was visualized using a choropleth map generated with ArcGIS Desktop version 10.8. Among the 18,060 screened individuals, 3668 (20.31%) had positive QFT-Plus results when calculated using all tested participants as the denominator. Among participants with determinate results ( n = 16,477), the QFT-Plus positivity rate was 22.26%, while 1583 (8.77%) had indeterminate results. In the GLMM analysis, older age (adjusted odds ratio [aOR] = 1.03, 95% CI 1.02–1.03; p < 0.001), male sex (aOR = 1.59, 95% CI 1.47–1.72; p < 0.001), and smoking (aOR = 1.21, 95% CI 1.05–1.41; p = 0.011) were significant factors associated with QFT-Plus positivity after adjustment for diabetes, hypertension, infection with human immunodeficiency virus, hepatitis C virus, and hepatitis B virus, region, and patient load, while accounting for clustering at the governorate level. Descriptive geographic mapping showed substantial geographic variation in LTBI prevalence across governorates. Regional QFT-Plus positivity among participants with determinate QFT-Plus results was similar in Nile Delta (22.5%) and Upper Egypt (21.7%), although marked heterogeneity was observed. The highest positivity rates were reported in Luxor (27.1%) and Sharqiya (25.7%). Geographic variation was also observed in indeterminate QFT-Plus results. These findings support further evaluation of structured LTBI screening and follow-up pathways within renal care services, particularly for older male patients and smokers. Targeted surveillance strategies may facilitate identification of individuals at increased risk and help inform future TB prevention policies in this population. Additional prospective studies should evaluate treatment uptake, progression to active TB, clinical benefit, cost-effectiveness, and optimal screening strategies.