Lab Case Study of Implementing Interferon – Gamma Release Assays in Public Health
Thor Elliott, Microbiologist KDHE TB Lab
Setbacks
• Budgets cuts
• Courier cuts
• Manpower cuts
• Clear direction
• Budgets cuts
• Courier cuts
• Manpower cuts
• Clear direction
Timeline
• Spring 2008 – Validation study
• Fall 2008 our first school, Emporia Sate University tested used IGRA testing to screen their international student population.
• Fall 2008 Our first use of IGRA testing in a case investigation.
• January 2009 What have we done!
Reorganization
• We are a PUBLIC HEALTH LAB!
• Did not want to be in competition with commercial labs.
• Defined our four areas of testing
• Began planning a “new order” (YES! see slide 1) to handle who we will test for, how we will bill them, and most importantly how we will train them.
• We are a PUBLIC HEALTH LAB!
• Did not want to be in competition with commercial labs.
• Defined our four areas of testing
• Began planning a “new order” (YES! see slide 1) to handle who we will test for, how we will bill them, and most importantly how we will train them.
4 types get in - Identifying the Criteria for Testing
The TB lab and the TB Program agreed it was important to maintain the role of public health and to not enter into an area that would have us competing with the commercial labs for IGRA testing.
Four areas for testing were indentified:
• Post Secondary Educational Facilities that have entered into a contract for testing with KDHE
• Screening Purposes that would be done mainly by County Health Departments that have also contracted with the state.
• Contact Investigations paid for by the TB program as a contact investigation tool with pre approval by the lab and program.
• Refugees tested by county health departments involved in the KDHE Refugee Program and paid for by that program.
Logistics
Option 1: Collect blood, transport @ RT, sample is good for 16 hours
Option 2: Collect blood, incubate on transport @ RT, sample is good for 3 days Option 3: Collect blood, incubate on site, centrifuge on site, transport at 2--8C, sample is good for 28 days
Issues
• Incubators on site.
• Training
• Courier routes and Friday deliveries
• Pre-authorizations
• Incubators on site.
• Training
• Courier routes and Friday deliveries
• Pre-authorizations
• We have implemented a successful screening tool for post secondary education facilities.
• We have many of our higher incidence health depts. using IGRA correctly.
• We have an important tool for the states refugee program.
• We have gone from testing a few hundred in ’08 to almost 2000 in ’09 and on track for 3000 or more in 2010.
• It’s not world dominance but I’m ok with that.
