O2101: Find it and treat it in clinic: Pediatric outcomes during system-wide optimization for latent tuberculosis infection diagnosis and treatment

Purpose/Objectives: The American Academy of Pediatrics recommends tuberculosis (TB) screening with interferon-gamma release assay (IGRA) for pediatric patients ≥2 years from regions with higher TB incidence as well as treatment of those with latent tuberculosis infection (LTBI) to prevent progression to TB disease. Despite these recommendations, risk-directed screening in primary care settings remains uncommon. Objectives were to optimize TB screening and LTBI diagnosis and treatment across a system of federally qualified health centers (FQHCs), compare baseline and intervention pediatric screening and IGRA positivity rates, and describe LTBI diagnosis and treatment outcomes and demographic characteristics of pediatric patients with positive IGRAs.

Design/Methods: We implemented an electronic medical record (EMR) alert to identify eligible patients (born in a higher TB incidence country, no record of previous screening/treatment) during primary care visits. Optimization included streamlined workflows, enhanced EMR tools, culturally and linguistically responsive materials, staff trainings, clinical pharmacist treatment management, and collaboration with a multicultural, multilingual navigation team. We compared baseline and intervention screening and positivity rates with McNemar’s and chi-square tests among patients aged 2-17 years. We evaluated chest radiography and LTBI treatment outcomes and demographic characteristics of pediatric patients with positive IGRAs using descriptive statistics. Baseline group included those seen 10/1/2020-9/30/2022. Intervention group included those seen from when their clinic rolled out (4 phases from 10/2022-1/2024) to 9/30/2024.

Results: Pediatric TB screening increased by 57% from baseline (825/2,919) to intervention (1,345/3,067) (p <.0001). Positivity rates were similar: 3.2% baseline and 2.6% intervention (p=0.45). For the entire pediatric cohort (baseline and intervention), 78% of IGRAs were ordered and drawn on the same day. Chest radiography completion and LTBI treatment initiation and completion rates were 93.9%, 78.8%, and 66.7%, respectively, and screening identified one pulmonary TB case. Table 1 shows demographic characteristics of pediatric patients with positive IGRAs.

Conclusion/Discussion: Optimization of TB screening and LTBI diagnosis and treatment across a system of FQHCs was associated with increased pediatric screening rates. Chest radiography and LTBI treatment rates were high for the pediatric population. Next steps include further evaluation of unscreened eligible pediatric patients to identify other opportunities for improvement in screening, treatment, and diagnosis.