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

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: Local data collection.

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: Local data collection.

Outcome

TB incidence.

Data source: Local data collection. National and regional data on TB incidence in England are collected in Public Health England's 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 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 (2016) NICE guideline NG33, 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, recommendation 1.2.1.3, and the glossary from the full guideline on tuberculosis]

Equality and diversity considerations

Healthcare professionals referring adults with HIV for latent TB testing infection should be aware of and be sensitive to the fact that they may feel stigmatised because of their diagnosis of HIV.