Quality standard
Quality statement 2: Latent tuberculosis testing for adults with HIV
Quality statement 2: Latent tuberculosis testing for adults with HIV
Quality statement
Adults aged under 65 years who are diagnosed with HIV, are tested for latent tuberculosis (TB) infection.
Rationale
People with HIV are considered to have a high risk of progression to active TB because they are severely immunocompromised. Testing people when they are diagnosed with HIV can lead to early detection and treatment of latent infection before it progresses to active disease. This can prevent onward transmission and the associated harms and costs of active TB.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that adults aged under 65 years who are diagnosed with HIV, are referred for testing for latent TB infection.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service protocols.
Process
Proportion of adults aged under 65 years diagnosed with HIV, who are tested for latent TB infection.
Numerator – the number in the denominator who are tested for latent TB infection.
Denominator – the number of adults aged under 65 years diagnosed with HIV.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
Outcome
TB incidence.
Data source: National and regional data on TB incidence in England is collected in the Office for Health Improvement and Disparities' TB strategy monitoring indicators.
What the quality statement means for different audiences
Service providers (primary, secondary and specialist care services) have systems in place for adults who have been diagnosed with HIV, aged under 65 years, to be referred for testing for latent TB infection.
Healthcare professionals (such as specialists, GPs and nurses) refer adults who have been diagnosed with HIV, aged under 65 years, for latent TB infection testing.
Commissioners (NHS England, integrated care systems and clinical commissioning groups) ensure that they commission services that refer adults who are diagnosed with HIV, aged under 65 years, to a service that undertakes testing for latent TB infection.
Adults with HIV, who are aged under 65 years, have a test to find out if they have TB.
Source guidance
Tuberculosis. NICE guideline NG33 (2016), recommendation 1.2.1.3
Definitions of terms used in this quality statement
Testing for latent TB infection in adults with HIV
For adults with HIV, an interferon-gamma release assay (IGRA) and a concurrent Mantoux test should be used.
The Mantoux test is a type of tuberculin skin test in which tuberculin is injected into the skin. The injection site is examined for signs of an immune response after 2 to 3 days. The IGRA test is a blood test used to diagnose latent TB based on the response of white blood cells to TB antigens.
[Adapted from NICE's guideline on tuberculosis, full guideline glossary and recommendation 1.2.1.3]