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. 2023 Nov 1;10(11):ofad545.
doi: 10.1093/ofid/ofad545. eCollection 2023 Nov.

Prior Screening for Latent Tuberculosis Among Patients Diagnosed With Tuberculosis Disease: Missed Opportunities?

Heidi Fischer  1 , Lei Qian  1 , Zhuoxin Li  1 , Saadiq Garba  2 , Katia J Bruxvoort  1   3 , Jacek Skarbinski  4   5 , Jennifer H Ku  1 , Bruno J Lewin  6   7 , Parag S Mahale  1 , Sally F Shaw  1 , Brigitte C Spence  1 , Sara Y Tartof  1   2
Affiliations

Prior Screening for Latent Tuberculosis Among Patients Diagnosed With Tuberculosis Disease: Missed Opportunities?

Heidi Fischer et al. Open Forum Infect Dis. .

Abstract

Background: California has the largest number of tuberculosis (TB) disease cases in the United States. This study in a large California health system assessed missed opportunities for latent tuberculosis (LTBI) screening among patients with TB disease.

Methods: Kaiser Permanente Southern California patients who were ≥18 years old with membership for ≥24 months during the study period from 1 January 2008 to 31 December 2019 were included. Prior LTBI test (tuberculin skin test or interferon-γ release assay) or diagnosis code prior to TB disease diagnosis was assessed among patients with observed TB disease (confirmed by polymerase chain reaction and/or culture). In the absence of current treatment practices, more patients screened for LTBI may have developed TB disease. We estimated hypothetical TB disease cases prevented by multiplying LTBI progression rates by the number of LTBI-positive patients prescribed treatment.

Results: A total of 1289 patients with observed TB disease were identified; 148 patients were LTBI positive and 84 were LTBI negative. Patients not prescreened for LTBI made up 82.0% of observed TB disease cases (1057/1289). Adding the hypothetical maximum estimate for prevented cases decreased the percentage of patients who were not prescreened for LTBI to 61.7% [1057/(1289 + 424)].

Conclusions: One-fifth of patients were screened for LTBI prior to their active TB diagnosis. Assuming the upper bound of cases prevented through current screening, almost 62% of TB disease patients were never screened for LTBI. Future work to elucidate gaps in LTBI screening practices and to identify opportunities to improve screening guidelines is needed.

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Conflict of interest statement

Potential conflicts of interest. The authors: No reported conflicts of interest.

Figures

Figure 1.
Figure 1.
Algorithm to estimate prevented tuberculosis disease cases through current screening. Abbreviations: LTBI, latent tuberculosis infection; TB, tuberculosis.
Figure 2.
Figure 2.
Observed and prevented tuberculosis (TB) disease cases, 2008–2019, by latent tuberculosis infection (LTBI) testing and diagnosis patterns.
Figure 3.
Figure 3.
Percentage of tuberculosis (TB) disease cases not prescreened for latent tuberculosis infection (LTBI), as a function of the hypothetical progression rate.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention . Basic TB facts. 2016. . Available at: https://www.cdc.gov/tb/topic/basics/default.htm. Accessed 21 March 2023.
    1. Centers for Disease Control and Prevention . Latent TB infection and TB disease. 2014. . Available at: https://www.cdc.gov/tb/publications/factsheets/general/ltbiandactivetb.htm. Accessed 21 March 2023.
    1. Centers for Disease Control and Prevention . TB risk factors. 2016. . Available at: https://www.cdc.gov/tb/topic/basics/risk.htm. Accessed 21 March 2023.
    1. Barry CE, Boshoff HI, Dartois V, et al. The spectrum of latent tuberculosis: rethinking the biology and intervention strategies. Nat Rev Microbiol 2009; 7:845–55. - PMC - PubMed
    1. Migliori GB, Ong CW, Petrone L, D’Ambrosio L, Centis R, Goletti D. The definition of tuberculosis infection based on the spectrum of tuberculosis disease. Breathe 2021; 17:210079. - PMC - PubMed