Infectious Disease

Almost half of providers skip TB testing for high-risk patients

Evan Vega November 5, 2023

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November 03, 2023

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Key takeaways:

Almost half of health care providers in the United States reported not routinely testing non-U.S.-born patients for TB.
The CDC recommends testing at-risk patients, including those born outside the country.

Almost half of health care providers in the United States do not routinely test patients born outside the U.S. for tuberculosis, despite CDC recommendations that say they should, a survey found.

According to the CDC, “country of birth continues to be a major risk factor for TB in the United States, with the majority of reported TB cases occurring among non-U.S.-born persons.”

IDN1123Caruso_Graphic_01_WEB

Data derived from Caruso E, et al. MMWR Morb Mortal Wkly Rep. 2023;doi:10.15585/mmwr.mm7244a2.

In 2022, that proportion was 73%, according to Elise Caruso, MPH, and colleagues from the CDC’s Division of Tuberculosis Elimination.

“CDC recommends testing persons at increased risk for tuberculosis infection as part of routine health care, using TB blood tests, when possible, and, if a diagnosis of latent TB infection (LTBI) is made, prescribing a rifamycin-based, 3- or 4-month treatment regimen (short-course) to prevent the development of TB disease,” Caruso and colleagues wrote in MMWR.

For their new study, Caruso and colleagues analyzed data from the 2020-2022 Porter Novelli DocStyles survey, which asked health care providers (HCPs) if they routinely test non-U.S.-born patients for TB and what LTBI treatment regimens they prescribe, if any.

A little more than half of 3,647 respondents (53.3%) reported routinely testing non-U.S.-born patients for TB, whereas 39.6% reported not regularly testing them and 7% reported referring them to a health department for testing.

Among 1,945 HCPs who reported regularly testing non-U.S.-born patients for TB, 44.2% used TB skin tests, 35.7% used TB blood tests and 20.2% used TB skin tests and blood tests, according to the responses.

Among respondents who reported routinely testing non-U.S.-born patients, most were pediatricians (63.1%), were aged older than 55 years (60.3%), have been practicing for more than 25 years (60.4%) and practiced in a group outpatient setting (56.7%).

The survey also found that the highest percentage of HCPs reporting that they did not regularly test non-U.S.-born patients for TB were worked in inpatient or hospital practices (50.2%), whereas those who most commonly reported referring non-U.S.-born patients to a health department for TB testing were nurse practitioners (14.1%) and providers working in rural settings (12.8%).

Additionally, the survey revealed that among all respondents, 33% reported prescribing recommended short-course regimens to treat LTBI, 37% reported prescribing longer course treatments and 40.9% reported referring patients to a health department for LTBI treatment.

HCPs who most commonly prescribed short-course treatment included internists (41.1%), those practicing in urban settings (39.4%) and in inpatient or hospital practices (39.7%), whereas the highest percentages of providers who reported referring patients to a health department for LTBI treatment were nurse practitioners (64.3%), physician assistants (60.7%) and those working in rural settings (56.4%).

“Identifying and overcoming barriers to recommended testing and treatment is important to prevent disease and achieve TB elimination goals,” the authors concluded.