The limited extent of experimental evidence regarding direct access to MLDPs contrasts with their widespread use across Europe, the United States, and the southern hemisphere. Suggestions are made for a research program to improve the evidence base for direct access.

The present study evaluated the accuracy of a risk assessment questionnaire (RAQ) for identifying candidates for tuberculin testing. A 33-question RAQ was administered to students before they underwent tuberculin screening at Virginia Commonwealth University (Richmond). Test operating characteristics for the complete and abbreviated RAQs compared to tuberculin skin test (TST) results were determined. Of 5382 students screened, 125 (2.3%) had a positive TST result; 113 (90.4%) of these 125 students had >or=1 affirmative response on the RAQ (i.e., a "positive RAQ"). The prevalence of TST positivity among students not born in the United States was 33.2-fold higher than that among students born in the United States. A 2-question RAQ had a sensitivity of 81.6%, a specificity of 91.0%, and positive and negative predictive values of 17.7% and 99.5%, respectively. Risk assessment can be an accurate means of identifying candidates for tuberculin screening.

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