Audit to assess adequacy of Screening of latent TB in Newly diagnosed HIV patients

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Introduction Patients with Human Immunodeficiency Virus (HIV) are at an increased risk of latent Tuberculosis (TB) reactivation. HIV TB concurrent infection increases mortality and reduces patient quality of life. Screening for latent TB allows treatment to commence, preventing reactivation. In accordance with British HIV association guidelines, all patients should have a Chest X-ray (CXR) at diagnosis. If patients are determined to be at a high risk of TB, an Interferon Gamma Release Assay (IGRA) test should be done to determine previous exposure to TB. Methods 95 HIV positive patients diagnosed between 2012-2017 at the Royal Victoria Infirmary (RVI) were assessed for inclusion. 4 patients excluded as they had active TB, n=91. Patients were determined to be high risk if they were from an African or Asian country of origin, or if they had a CD4 count below 200 cells/mm3. Clinic letters and results on eRecord were reviewed (n=95) between 16/02/2019- 21/03/2019. Results 61.5% of patients had a CXR at diagnosis. 72.5% of patients had a CXR or a CT scan. 8 patients had an IGRA test performed, of which 2 were inconclusive. 20% of patients from Africa and 0% of patients from Asia had an IGRA test. Of those patients with a CD4 count below 200 cells/mm3 9.1% had an IGRA test. Discussion An assessment of patient TB risk may need to be undertaken to allow thorough latent TB screening using IGRA tests. Automatic IGRA tests could be done on all patients with a CD4 count <200 cells/mm3.

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