Dewan Puneet Kumar, Grinsdale Jennifer, Liska Sally, Wong Ernest, Fallstad Robert, Kawamura L Masae
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
BMC Infect Dis. 2006 Mar 15;6:47. doi: 10.1186/1471-2334-6-47.
The whole-blood interferon-gamma release assay (IGRA) is recommended in some settings as an alternative to the tuberculin skin test (TST). Outcomes from field implementation of the IGRA for routine tuberculosis (TB) testing have not been reported. We evaluated feasibility, acceptability, and costs after 1.5 years of IGRA use in San Francisco under routine program conditions.
Patients seen at six community clinics serving homeless, immigrant, or injection-drug user (IDU) populations were routinely offered IGRA (Quantiferon-TB). Per guidelines, we excluded patients who were <17 years old, HIV-infected, immunocompromised, or pregnant. We reviewed medical records for IGRA results and completion of medical evaluation for TB, and at two clinics reviewed TB screening logs for instances of IGRA refusal or phlebotomy failure.
Between November 1, 2003 and February 28, 2005, 4143 persons were evaluated by IGRA. 225(5%) specimens were not tested, and 89 (2%) were IGRA-indeterminate. Positive or negative IGRA results were available for 3829 (92%). Of 819 patients with positive IGRA results, 524 (64%) completed diagnostic evaluation within 30 days of their IGRA test date. Among 503 patients eligible for IGRA testing at two clinics, phlebotomy was refused by 33 (7%) and failed in 40 (8%). Including phlebotomy, laboratory, and personnel costs, IGRA use cost $33.67 per patient tested.
IGRA implementation in a routine TB control program setting was feasible and acceptable among homeless, IDU, and immigrant patients in San Francisco, with results more frequently available than the historically described performance of TST. Laboratory-based diagnosis and surveillance for M. tuberculosis infection is now possible.
在某些情况下，全血干扰素-γ释放试验（IGRA）被推荐作为结核菌素皮肤试验（TST）的替代方法。IGRA用于常规结核病（TB）检测的现场实施结果尚未见报道。我们评估了在旧金山常规项目条件下使用IGRA 1.5年后的可行性、可接受性和成本。
在为无家可归者、移民或注射吸毒者（IDU）人群服务的六家社区诊所就诊的患者常规接受IGRA（QuantiFERON-TB）检测。根据指南，我们排除了年龄小于17岁、感染HIV、免疫功能低下或怀孕的患者。我们查阅了医疗记录以获取IGRA结果和结核病医学评估的完成情况，并在两家诊所查阅了TB筛查日志以了解IGRA拒绝或静脉穿刺失败的情况。
在2003年11月1日至2005年2月28日期间，4143人接受了IGRA检测。225份（5%）标本未检测，89份（2%）IGRA结果不确定。3829份（92%）标本获得了阳性或阴性IGRA结果。在819例IGRA结果阳性的患者中，524例（64%）在IGRA检测日期后的30天内完成了诊断评估。在两家诊所符合IGRA检测条件的503例患者中，33例（7%）拒绝静脉穿刺，40例（8%）静脉穿刺失败。包括静脉穿刺、实验室和人员成本，每例接受检测的患者使用IGRA的成本为33.67美元。
在旧金山的常规结核病控制项目环境中实施IGRA对无家可归者、IDU和移民患者是可行且可接受的，其结果比历史上描述的TST表现更频繁可得。基于实验室的结核分枝杆菌感染诊断和监测现在成为可能。
