title: Impact of Routine Quantiferon Testing on Latent Tuberculosis Diagnosis and Treatment in Refugees in Multnomah County, Oregon, November 2009-October 2012.
abstract: Interferon-gamma release assays have potentially been transformative to screening programs focused on latent tuberculosis infection (LTBI) in foreign-born persons. We sought to add to this assessment by presenting the impact of a well-established refugee screening and treatment program switching from skin testing to Quantiferon(®)-TB Gold (QFT). We completed a retrospective cohort of refugees screened for tuberculosis between November 1, 2009-April 30, 2011 (pre-QFT) and May 1, 2011-October 31, 2012 (post-QFT). Among 2244 refugees screened that met the inclusion criteria, there was a significant difference in the proportion of refugees diagnosed with LTBI between the two time periods (p = <0.0001). In multivariate analysis, refugees tested with QFT had a greater odds of treatment initiation (adjusted odds ratio 1.53; 95% CI 1.02-2.29, p = 0.040). However, test type had no impact on treatment completion (odds ratio 0.88; 95% CI 0.57-1.36, p = 0.560). Although we demonstrated increased efficiency in LTBI diagnosis in this group, treatment completion rates indicate other barriers to treatment that must be addressed.
authors.affiliation: Communicable Disease Services, Multnomah County Health Department, 426 SW Stark Street, 3rd Floor, Portland, OR, 97204, USA. jaime.walters@multco.us.
authors.forename: Jaime K
authors.initials: JK
authors.lastname: Walters
authors.affiliation: Communicable Disease Services, Multnomah County Health Department, 426 SW Stark Street, 3rd Floor, Portland, OR, 97204, USA.
authors.forename: Amy D
authors.initials: AD
authors.lastname: Sullivan
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D015331:Cohort Studies; D003140:Communicable Disease Control / Q000458:organization & administration*; D005260:Female; D006801:Humans; D059425:Interferon-gamma Release Tests / Q000379:methods*; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009922:Oregon / Q000453:epidemiology; D010865:Pilot Projects; D015995:Prevalence; D011634:Public Health; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D055815:Young Adult
keywords: Diagnosis; Latent tuberculosis; Refugee; Treatment completion; Treatment initiation; Tuberculosis