Pairing QuantiFERON gold in-tube with opt-out HIV testing in a tuberculosis contact investigation in the Southeastern United States.
Knowing one's HIV status is particularly important in the setting of recent tuberculosis (TB) exposure. Blood tests for assessment of tuberculosis infection, such as the QuantiFERON Gold in-tube test (QFT; Cellestis Limited, Carnegie, Victoria, Australia), offer the possibility of simultaneous screening for TB and HIV with a single blood draw. We performed a cross-sectional analysis of all contacts to a highly infectious TB case in a large meatpacking factory. Twenty-two percent were foreign-born and 73% were black. Contacts were tested with both tuberculin skin testing (TST) and QFT. HIV testing was offered on an opt-out basis. Persons with TST >or=10 mm, positive QFT, and/or positive HIV test were offered latent TB treatment. Three hundred twenty-six contacts were screened: TST results were available for 266 people and an additional 24 reported a prior positive TST for a total of 290 persons with any TST result (89.0%). Adequate QFT specimens were obtained for 312 (95.7%) of persons. Thirty-two persons had QFT results but did not return for TST reading. Twenty-two percent met the criteria for latent TB infection. Eighty-eight percent accepted HIV testing. Two (0.7%) were HIV seropositive; both individuals were already aware of their HIV status, but one had stopped care a year previously. None of the HIV-seropositive persons had latent TB, but all were offered latent TB treatment per standard guidelines. This demonstrates that opt-out HIV testing combined with QFT in a large TB contact investigation was feasible and useful. HIV testing was also widely accepted. Pairing QFT with opt-out HIV testing should be strongly considered when possible.
Person
Anna K
AK
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. perso006@mc.duke.edu
Goswami
Neela D
ND
Bissette
Deborah J
DJ
Turner
Debra S
DS
Baker
Ann V
AV
Gadkowski
L Beth
LB
Naggie
Susanna
S
Erlandson
Kirby
K
Chen
Luke
L
Lalani
Tahaniyat
T
Cox
Gary M
GM
Stout
Jason E
JE
D000328:Adult; D000368:Aged; D016358:Contact Tracing; D003430:Cross-Sectional Studies; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007371:Interferon-gamma / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000276:immunology; D012189:Retrospective Studies; D015144:Southeastern United States / Q000453:epidemiology; D014374:Tuberculin Test / Q000379:methods; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission*; D019562:Viral Load; D055815:Young Adult
D015483:HIV Antibodies; D007371:Interferon-gamma