“…However, this problem is of a smaller scale in countries with high prevalence of LTBI in HCW; for example, 16.3, 6.5 and 2.3% of the HCW with a positive IGRA in Georgia, Portugal and Spain, respectively, had a negative TST [13,23,53]. The second study from Spain comprising young, unexposed students found a low prevalence of LTBI and a high proportion of TST-negative healthcare Review students (37.5%) in those with a positive IGRA [55]. Therefore, two-step screening cannot be recommended for a country or a population with a low incidence of TB, while, for a country with a higher incidence of TB, the problem of underestimation seems to be on a scale that might be acceptable.…”