Collaborative Effort between TB Control Program and TB Laboratory Leads to Successful Implementation of Quantiferon Gold In-Tube Service
T.L. Elliott, P.E. Griffin, Kansas Department of Health and Environment, Topeka Kansas
Background and Objective: With the introduction of IGRAs, Kansas immediately began to consider the possibilities and impact on TB eliminations efforts in the state. Given that more than two-thirds of cases each were among person born outside of the US and many had contacts who were BCG vaccinated it was determined one area of use for the tests would be contacts. It was also observed that 15 – 20% of cases each year were among international students in our colleges and universities, thus establishing another use for the test. The objective was to establish a Quantiferon Gold In-Tube (QFT) service in a rural state that will meet Public Health best practice needs at an affordable cost to target audience.
Methods: Review of current literature to determine the most important target audiences. Market analysis conducted to determine current service availability and cost as well as realistic access to current services by the target audiences. Target audiences surveyed to establish a demand for the service that is not being met.
Results: The Kansas Public Health TB Laboratory became a validated provider of the QFT service. The Kansas TB Control Program targeted two populations for initial roll out of service, state universities screening high risk incoming students (generally international students with BCG vaccination) and high risk contacts identified in contact investigations statewide. In three years, the program has grown from processing less than two hundred tests in 2008 to an expected two thousand tests in 2010. Laboratory costs are neutral with reimbursement arrangements contracted with submitters. TB Control Program costs are decreased as a resulted of fewer required follow up expenditures for contacts that were BCG vaccinated and previously had questionable screening results.
Conclusions: In Kansas, a successful, cost effective and growing QFT service has been established. Such a service would not have been possible without a willing collaboration of the TB laboratory and TB program.
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Implementation of a QuantiFERON-TB Gold Screening Program in a Public Health Clinic Setting
NiiAmah Stephens, MPH, CPH; Susan Dorman, MD; Sherry Ketemepi, MPH; Adena Greenbaum, MD, MPH; Nicketta Johnson, RN, BSN
Baltimore City Health Department (BCHD), Johns Hopkins Center for TB Research, Johns Hopkins Hospital
Background/Statement of Problem: For more than a century, the mainstay of latent tuberculosis detection has been the tuberculin skin test (TST). However, TST screening requires at least two interactions with a health worker, reading TSTs can be highly subjective, and result interpretation can be difficult among BCG-vaccinated individuals. Interferon-gamma release assays, such as the QuantiFERON-TB Gold (QFT-G) test, overcome these obstacles, may improve staff efficiency, and may be more cost-effective, but data on their use in public health clinic settings have been very limited.
Methods: The Baltimore City TB Control Program, BCHD’s BDC Laboratory, and Johns Hopkins partners met several times over 6 months to design a pilot program that would assess the feasibility of QuantiFERON-based screening in BCHD TB clinics; evaluate impact on contact investigation completion rates; evaluate impact on screening of BCG-vaccinated individuals; and costs and cost-effectiveness of implementation in a routine TB program setting.
Results: Health Department staff and Hopkins partners developed Standard Operating Procedures detailing eligibility criteria for QuantiFERON screening, how and when samples will be collected, and how often batches will be run at the laboratory. Background materials were developed to explain the new test to clinic patients, and the test manufacturer trained nurses and laboratory staff on appropriate phlebotomy and analysis techniques. Program evaluation will use a retrospective cohort approach that enables modeling of clinical efficiency, program effectiveness, and cost-effectiveness. TB screening using QFT-G began in Baltimore City’s Eastern District Health Center on March 1, 2010.
Conclusion: The initial implementation of QFT-G testing has been feasible in a local health department setting. Assessment of impact on patient-centered and program outcomes is underway. The data collected during this pilot program will be useful in determining the cost-effectiveness of broader QFT-G adoption.
