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Clearly we need a new more precise test to identify LTBI. To be of value, that new test must minimize unnecessary and costly additional testing and treatment of false-positives. Ideally, it should also reduce the number of false-negatives. The inherent problem is that we have no gold standard for identifying the infected.
As long as we continue to compare new diagnostic products to the TST, our progress will be very limited. Even though we are more comfortable with the PPD, we need to put it, with the horse, out to pasture and move on. We need to focus on the new test, not the old
2009—Is there still a role for the tuberculin skin test? What history has taught us
John A Sbarbaro, MD, MPH, FCCP
Professor of Medicine & Preventive Medicine,
Professor of Medicine & Preventive Medicine,
University of Colorado, School of Medicine, Denver, CO, USA
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IGRAs are a significant advance because of their high specificity and operational advantages. They are powerful epidemiology tools. Leadership and advocacy are keys in implementation.and in the questions;
When advocating the use of IGRAs, it is important to focus on the potential benefit to patients and society. Start-up funding remains the biggest obstacle, but the real question is: ‘Is TB control worth it to society?’ Be creative, apply for grants. In the USA, our generally passive TB control culture may be the largest obstacle. It will not be hard to prove to providers the value of switching to the IGRAs, as they understand the shortcomings of the TST.
Q: I would like to see more information on the use of QFT and acceptance of preventive therapy.
A: Our staff is really excited about this, and they can see the difference in patient acceptance.
IGRAs in public health practice: overcoming obstacles to implementation
Masae Kawamura, MD
Director, TB Control Section, San Francisco, Department of Public Health,
Director, TB Control Section, San Francisco, Department of Public Health,
Francis J. Curry National Tuberculosis Center,
University of California, San Francisco, CA, USA
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A common factor of all these examples is that IGRA was used for all the investigations due to decisions by the incident management team that the IGRAs provide a more practical and efficient approach to handling large numbers of exposed persons.and in questions;
Q: Our result rates for contacts and staff are better and the staff certainly happier with QFTs. How about in London?
A: In large incidents, the IGRAs are a lot easier and more efficient. The problem is in very young children, where the results are less reliable and obtaining blood from very young children may be more difficult.
Implementing IGRAs in the UK: constraints and opportunities
Ibrahim Abubakar, MBBS, PhD, FFPH
Head of Section/Consultant Epidemiologist, Tuberculosis Section,
Head of Section/Consultant Epidemiologist, Tuberculosis Section,
HPA Centre for Infections, Colindale, London, UK
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