title: Enhanced Tuberculosis Infection Treatment Outcomes after Implementation of QuantiFERON®-Gold Testing.
abstract: BACKGROUND
  Use of the tuberculin skin test (TST) for diagnosis of latent tuberculosis infection (LTBI) among individuals who received the Bacille Calmette-Guérin (BCG) vaccine is complicated by its potential cross-reaction with TST antigens which may cause false-positive results and lead to patient and physician reluctance to initiate LTBI treatment. QuantiFERON®-TB Gold (QFT-G) lacks this cross-reaction. We sought to study the impact of implementing QFT-G testing in 2006 on LTBI treatment initiation and completion at NYC chest clinics.
  
  
  METHODS
  QFT-G results from 10/2006-12/2008 in NYC Department of Health and Mental Hygiene chest clinics were obtained from the electronic medical record system. The proportions of patients who initiated and completed treatment among patients tested with QFT-G were compared to those tested with TST from 10/2004-9/2006.
  
  
  RESULTS
  Among 36,167 patients tested with QFT-G, 2,300 (6%) tested positive, 33,327 (93%) tested negative, and 540 (1%) had an indeterminate result. Among those who had a positive QFT-G test and deemed eligible, 985 (80%) initiated LTBI treatment and 490 (40%) completed treatment. Historically, among patients tested with TST, 7,073 (19%) tested positive (p<0.0001 compared to QFT-G); 3,182 (79%) of those eligible initiated LTBI treatment and 1,210 (30%) completed treatment (p<0.0001 compared to QFT-G).
  
  
  CONCLUSIONS
  QFT-G implementation increased the proportion of patients completing LTBI treatment. Additional studies are needed in more settings to determine whether using QFT-G leads to a sustained increase in treatment completion.
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York, United States of America.
authors.forename: Aldo
authors.initials: A
authors.lastname: Crossa
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York, United States of America; Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors.forename: Jason
authors.initials: J
authors.lastname: Kessler
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York, United States of America.
authors.forename: Tiffany G
authors.initials: TG
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D019937:Diagnostic Techniques and Procedures; D005260:Female; D006801:Humans; D007223:Infant; D007371:Interferon-gamma / Q000378:metabolism; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007371:Interferon-gamma