P2.271: Don’t Forget About TB – Improving Routine Latent Tuberculosis Screening and Testing During 12 to 24 months Well Child Visits

Purpose/Objectives: In children 1-2 years of age, the risk of reactivation of latent tuberculosis infection (LTBI) to tuberculosis (TB) is 25%. Early detection and treatment of LTBI are crucial to prevent health complications. In May 2024, the American Academy of Pediatrics (AAP) recommended Interferon-Gamma Release Assays (IGRAs), like QuantiFERON-TB Gold Plus (QFT-Plus), for children of all ages, replacing the Tuberculin Skin Test (TST) for children under 2. IGRAs offer higher specificity and sensitivity than TST and have a lower indeterminate rate in young children. This quality improvement project aimed to increase the percentage of QFT-Plus tests ordered for at-risk children aged 11-35 months during their 12 to 24 months well-child visits at a pediatric resident clinic from 9.4% in May 2024 to 50% by June 2025.

Design/Methods: Interventions included provider education and workflow adjustments. A required LTBI screening questionnaire was already in the EMR. Interventions primarily focused on resident education on accurate screening and testing. The QFT-Plus ordering rates of residents compared to attendings (process measure) were tracked monthly. In September and December 2024, email reminders were sent to resident physicians about TB risk factors, the screening process, and QFT-Plus ordering instructions. In February 2025, a SmartPhrase was added to the EMR to prompt providers to review IGRA results during well-child visits. The percentage of at-risk children (11-35 months) screened with QFT-Plus (outcomes measures) was tracked monthly. Non-English speaking status was used as a proxy to estimate the total at-risk patient population. This criterion was chosen because it likely includes children born in high-TB prevalence countries or those living with a relative born in such countries. Using non-English speaking status was the best way to utilize the EMR to quantify at-risk patients. This assumption underrepresents patients at risk for LTBI based on travel history or high-risk living situations.

Results: The initial goal of the project was surpassed by screening 67.2% of the at-risk patient population with a QFT-Plus test by February 2025. The highest improvement in screening rates was seen after the second round of educational email reminders. Resident QFT-Plus ordering rates also increased from 46% in September 2024 to 72% in January 2025, demonstrating the success of educational efforts in improving screening accuracy and ordering rates among residents.

Conclusion/Discussion: Although the initial goal was reached, there is still room for improvement. The primary strategy going forward is continued physician education through informational flyers in shared workspaces and presentations during resident lectures. Future interventions will focus on addressing barriers to testing, follow-ups, and physician responses to positive results as LTBI screening rates improve.