Abstract
BackgroundUse of the tuberculin skin test (TST) for diagnosis of latent tuberculosis infection (LTBI) among individuals who received the Bacille Calmette-Guérin (BCG) vaccine is complicated by its potential cross-reaction with TST antigens which may cause false-positive results and lead to patient and physician reluctance to initiate LTBI treatment. QuantiFERON®-TB Gold (QFT-G) lacks this cross-reaction. We sought to study the impact of implementing QFT-G testing in 2006 on LTBI treatment initiation and completion at NYC chest clinics.MethodsQFT-G results from 10/2006–12/2008 in NYC Department of Health and Mental Hygiene chest clinics were obtained from the electronic medical record system. The proportions of patients who initiated and completed treatment among patients tested with QFT-G were compared to those tested with TST from 10/2004–9/2006.ResultsAmong 36,167 patients tested with QFT-G, 2,300 (6%) tested positive, 33,327 (93%) tested negative, and 540 (1%) had an indeterminate result. Among those who had a positive QFT-G test and deemed eligible, 985 (80%) initiated LTBI treatment and 490 (40%) completed treatment. Historically, among patients tested with TST, 7,073 (19%) tested positive (p<0.0001 compared to QFT-G); 3,182 (79%) of those eligible initiated LTBI treatment and 1,210 (30%) completed treatment (p<0.0001 compared to QFT-G).ConclusionsQFT-G implementation increased the proportion of patients completing LTBI treatment. Additional studies are needed in more settings to determine whether using QFT-G leads to a sustained increase in treatment completion.
Highlights
Tuberculosis (TB) rates have declined in the United States (US) since the late 1990s as the HIV epidemic waned in addition to improvements in TB control infrastructure [1]
Among patients tested with TST, 7,073 (19%) tested positive (p
QFT-G implementation increased the proportion of patients completing LTBI treatment
Summary
Tuberculosis (TB) rates have declined in the United States (US) since the late 1990s as the HIV epidemic waned in addition to improvements in TB control infrastructure [1]. TB elimination is far from being achieved, partly due to the large reservoir of individuals with latent TB infection (LTBI). For LTBI treatment to be an effective strategy for achieving TB elimination, a sizeable proportion of those with LTBI must complete a 3–9 month treatment regimen. A large North American multisite study of LTBI screening and treatment found that only 46.6% of those testing TST positive completed treatment [5], a proportion that has remained unchanged during the last decade [6]. Use of the tuberculin skin test (TST) for diagnosis of latent tuberculosis infection (LTBI) among individuals who received the Bacille Calmette-Guérin (BCG) vaccine is complicated by its potential cross-reaction with TST antigens which may cause false-positive results and lead to patient and physician reluctance to initiate LTBI treatment. We sought to study the impact of implementing QFT-G testing in 2006 on LTBI treatment initiation and completion at NYC chest clinics.
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