Abstract
Introduction: The use of Anti-TNF alpha is increasing recently. In 2011 NICE recommended using IGRA for detecting latent TB. However there is uncertainty around the sensitivity of IGRA in immunosuppressed patients as well as regarding implementation of screening pathways.
Methods: In 2013 we implemented a TB screening pathway in collaboration with various departments in our hospital that use biological treatments.
IGRA is requested pre-biologics in patients with no evidence of active TB. If IGRA is positive or intermediate twice, patients are referred to the TB service. If negative, in patients on immunosuppression, epidemiological TB risk stratification is undertaken and high risk patients are referred to the TB service.
Retrospective analysis of 209 IGRA requests pre-biologics was done from Apr 14 – Mar 15
Results: Of the 175 patients with the negative results, 10 patients were of high epidemiological risk - 5 were on immunosupressants and of these 4 were referred to the TB services.
Of the 7 patients with positive results, five patients were referred and managed appropriately and two patients were not referred.
Of the 18 patients with indeterminate results, 12 patients had the test repeated. 8 patients had indeterminate results again and were referred. 3 patients were started on prophylaxis.
Conclusions: A TB screening pathway pre-starting biological treatment can be successfully implemented in collaboration with various departments.
Uncertainty remains regarding the sensitivity of IGRA in immunosuppression. However using a referral pathway for high risk, IGRA negative patients to TB services by defined criteria is feasible.
- Copyright ©the authors 2016
