QuantiFERON in California

Uncertainty about adopting IGRA, or more specifically QuantiFERON, exists amongst health care administrators. For some time California, and in particular San Francisco, has been pioneering the use of QuantiFERON and has been able to build up a store of knowledge. This store is now being put to good use in the seminar 2011: What Do We Know About LTBI? which was recently held at the Curry International Tuberculosis Center.

For instance;

LTBI Diagnosis (in a time of transition)

Clinic staff need to decide which test to take to the field. Which of the following would most strongly influence your choice?
1. Too hard to do blood draw, choose PPD <-- True in some situations
2 Avoid QFT because of logistics of getting blood to lab within 12 hours <-- No more 12 hour limit with QFT-IT
3. Use QFT because only one visit to get results <-- Yes, wasted effort if no show for PPD read
4. QFT because better correlation with exposure risks in contacts to TB <-- Early data suggests QFT may correlate better with exposure and progression

is using IGRAs a cost effective strategy?

Bottom line
• IGRAS are costly up front
• CE studies always show that TST more costly than QFT
• Savings are born from its higher specificity and elimination of waste
• QFT-GIT is affordable and will be cheaper with adequate reimbursement
• T-spot is not competitive at current prices
• Public health programs must be able to bill in order to sustain program

 They even looked at doctor attitudes to managing LTBI

Conclusions

• There are many features of primary care that impact screening and management of LTBI beyond the knowledge of guidelines

• Practice size, type, and the consequent resources contribute to a physicians capacity to track and manage LTBI in a busy primary care practice

• Private practice physicians are less familiar with current guidelines for treatment, and more concerned about insurance, and reimbursement for the care they provide than salaried public sector clinicians

• Educational interventions can improve knowledge of guidelines, but may have little impact on attitudes toward their implementation

• Future interventions should consider different approaches to different practice setting and address priority concerns beyond education