Latent Tuberculosis Infection Screening Among Human Immunodeficiency Virus (HIV)-Infected Patients: Tuberculin Skin Test Versus Interferon-Gamma Release Assay

Abstract

Background. National guidelines recommend screening for latent tuberculosis infection (LTBI) in all HIV+ patients. The study objective was to (1) measure adherence to guidelines and (2) determine whether transitioning from the tuberculin skin test (TST) to the interferon-gamma release assay (IGRA) improved screening adherence among HIV+ patients entering care at anHIV primary care clinic in Philadelphia, Pennsylvania. Methods. A retrospective cohort study using medical chart review was conducted using multivariable modified Poisson regression models to examine the association between LTBI screening within twelve months of entering care and factors of interest, including latent tuberculosis screening method. Successful screening was defined as placement and reading of a TST, performance of an IGRA, or receipt of records from an outside clinic documenting prior testing or treatment since HIV diagnosis. Results. Overall, 32% (n = 118 of 372) of patients received LTBI screening within twelve months of entering care. Transitioning to IGRA-based screening improved adherence (28% to 37%) but adherence remained suboptimal. In multivariable regression analysis, IGRA screening (adjusted risk ratio [ARR], 1.46; 95% confidence limit [CL], 1.07-1.99) and male sex (ARR, 1.48; 95% CL, 1.06-2.09) was associated with a higher likelihood of LTBI screening. Conclusion. Transitioning from TST to IGRA-based screening improved adherence to screening guidelines; however, less than 40% of HIV+ patients received LTBI screening. Further work is needed on how to most effectively increase screening rates among HIV+ patients in a primary care setting. (Table Presented) .