interferon-gamma release assays tuberculosis interferon-gamma release assays (IGRAs) (and the TST) should not be used in low- and middle-income countries for the diagnosis of pulmonary or extra-pulmonary TB, nor for the diagnostic work-up of adults (including HIV-positive individuals) suspected of active TB in these settings (strong recommendation). This recommendation places a high value on avoiding the consequences of unnecessary treatment (high false-positives) given the low specificity of tuberculosis interferon-gamma release assays (IGRAs) (and the TST) in these settings.