P016 IMPROVING TUBERCULOSIS RE SCREENING IN INFLAMMATORY BOWEL DISEASE PATIENTS RECEIVING BIOLOGIC THERAPY: A SINGLE CENTER QUALITY IMPROVEMENT INITIATIVE.

Abstract

Abstract Background Biological agents have revolutionized the management of inflammatory bowel disease (IBD). There is a known increased risk of tuberculosis (TB) reactivation with biologic therapy (1). ACG guidelines recommend screening for active and latent TB infection (LTBI) prior to starting certain biologic agents (2). However, there are no consensus guideline on the utility of yearly screening testing in IBD patients without TB risk factors. With a number of patients now receiving the biologic therapy outside their primary care centers it has become increasingly difficult to effectively provide ongoing TB screening. With this quality improvement exercise, we aim to improve TB re-screening in patients receiving biologics by completing a yearly phone screening for exposure history. Method An interdisciplinary team from GI and ID developed a TB risk factor screening questionairre, adapting the California Department of Public Health’s Pediatric TB Risk Assessment tool (3). A list of patients receiving biologics was sorted by month of birth in the EMR. When the current calendar month aligned with the patient’s birth month, a GI RN reviewed the TB questionnaire with the patient (≥18 yo) and/or legal guardian by phone. If one or more TB risk factors were identified, the GI RN would notify the provider and a QuantiFERON-TB Gold (QFT) was ordered to be completed. Results 60 patients were found on biologic therapy (median age 17 yo) (38 males, 22 females) (68% CD, 28% UC, 3.3% IBD-U)(75% IFX, 12% ADA, and 3% other) to be to eligible TB screening between January - July 2019, 48 patients completed the phone screening. All 61 patients had completed TB screening prior to starting biologic therapy, which was reported to be negative. 13 patients were unable to be reached. 6/48 were identified as having at least 1 risk factor for TB. 5/6 patients with a positive screen had a negative QFT. 1 patient was away at college and a request to his adult GI managing his biologic was sent. Conclusion Screening for LTBI is required prior to starting a biologic therapy, though there are no guidelines for routine TB screening following initiation of the biologic. We propose performing an annual phone screening for TB exposure history for IBD patients on biologic therapy. QTF testing remains appropriate in patients with potential risk factors, such as being a health care worker or travel to/living in high endemic TB regions. References