2021 ARPE Targeted Testing Report

About the Report

Background

Targeted testing is an effective prevention strategy for reducing the morbidity and mortality of tuberculosis (TB) disease in the United States. Targeted testing is used to identify and treat persons infected with M. tuberculosis, including active disease and latent TB infection. Identifying and treating persons who have latent TB infection is important as an estimated 80% of US TB cases are believed to be the result of longstanding, untreated latent TB infection.1

Beginning in 2020, CDC-funded state and city TB programs with ≥150 TB cases were required to submit targeted testing data (as outlined in the cooperative agreements) by entering the data into the ARPE form2 through the National Tuberculosis Indicators Project (NTIP) performance-monitoring tool.

Targeted testing data

This report focuses on targeting testing efforts in 2021. Because targeted testing reporting includes treatment outcomes, final reporting extends over a 12-month period. For example, this means that individuals with TB infection identified in December 2021 would have until December 2022 to finish treatment, and the data would then be reported in 2023.

Targeted testing data are submitted using the following 3 categories:

Project

Targeted testing project data include groups done at sites outside the health department, as determined by the needs or convenience of the groups being tested. Testing projects might be held once, or they might be recurrent (e.g., annual testing at a correctional facility) or ongoing (e.g., testing of all new admissions to a homeless shelter).

Individual

Targeted testing individual data include testing for individuals or groups that occurs outside of testing projects; testing is often done at a health department clinic.

Administrative

Administrative data include testing that is done when testing is a low public health priority because the tested persons or groups are not at risk for TB and might not be candidates for latent TB infection treatment. This testing is often required by regulations or policies created outside the TB control program.²

The number submitted in each category indicates the number of individuals the program classified under that category.

Reporting states and cities

The following states and cities reported targeted testing data in 2021: California, Florida, Georgia, Los Angeles, Massachusetts, New Jersey, New Mexico, New York City, New York State, North Carolina, Ohio, San Diego, Virginia, and Washington.

In addition, the following TB programs with <150 cases optionally reported targeted testing data for 2021: New Mexico, Massachusetts, and Ohio.

Data from some reporting areas was incomplete and the number of programs reporting varies by table, leading to differences in overall numbers between tables. Footnotes on each table in this report indicate which jurisdictions reported for each indicator.

Data summary

Of the 48,276 persons sought, enlisted, or registered for targeted testing in 2021 in this aggregate data set, 45,450 (94.1%) were evaluated for TB infection, 56 (0.1%) were diagnosed with TB disease, and 6,176 (13.6%) were diagnosed with latent TB infection.

Of those persons diagnosed with latent TB infection, 4,874 (78.9%) were considered candidates for treatment by the TB program. Persons with latent TB infection are counted in this category if they should receive treatment according to the treatment guidelines in effect at the time of testing. Counting under this category should be determined according to medical and epidemiological factors, even if treatment will not be prescribed because of other factors.

Of those considered candidates for treatment, 2,894 started treatment (59.4%). Of those that started treatment, 2,252 (77.8%) completed treatment (Table 1).

Reporting U.S.–born vs. non-U.S.–born status is currently optional. It is also optional to report the use of Interferon Gamma Release Assay (IGRA) and Tuberculin Skin Testing (TST). Of the 48,276 persons sought, enlisted, or registered for targeted testing in 2021, 24,892 were reported as U.S.- born and 8,009 were reported as non-U.S.- born. A total of 37,907 persons were tested with IGRA and 585 with TST, although reported use of these tests was not mutually exclusive.

Further analysis indicates that of the 360 patients who stopped treatment, as reported by 5 programs, 201 were identified as lost to follow-up. Of the 93 patients listed as stopping treatment, reasons listed included an adverse effect to the treatment (33), medical provider decision (16), moved (14), and death (3) (Table 3).

Targeted testing, 2021

Data shown in tables and figures are up to date as of September 11, 2023.

Table 1: Persons sought, enlisted, or registered for targeted testing

(N=12 reporting programs)

Table 1: Persons sought, enlisted, or registered for targeted testing (N=12 Reporting Programs)

	Targeted testing project*	Targeted testing individual†	Administrative§	Total
Sought, enlisted, or registered	34,354	8,956	4,966	48,276
U.S.–born¶	24,241	518	133	24,892
Non-U.S.–born¶	4,959	2,939	111	8,009
Evaluated	33,170	8,387	3,893	45,450
Tuberculin skin test (TST) ¶	205	263	118	585
Interferon Gamma Release Assay (IGRA) ¶	31,879	5,003	1,025	37,907
TB disease	6	30	20	56
Latent TB infection	3,566	2,155	455	6,176

Notes

Programs reporting for non-optional reporting fields include California, Los Angeles, San Diego, Florida, Georgia, Massachusetts, New Mexico, New York, New York City, North Carolina, Ohio, Virginia and Washington.

^*Targeted testing project: Usually, testing projects for groups are done at sites outside the health department, as determined for the convenience or by the needs of the groups being tested. Such testing projects might be done only once during a limited period, or they might be recurrent (e.g., annual testing at a correctional facility) or ongoing (e.g., testing of all new admissions to a homeless shelter).

^† Targeted testing individual: The sum of testing that is done one person at a time or by group but outside of testing projects, when testing is in accordance with national, state, or local guidelines for selecting persons who are at risk for TB and who are expected to be candidates for treatment if they have LTBI. The testing is often done at a health department clinic.

^§ Targeted testing administrative: Testing for LTBI that is done when testing is a low public health priority because the tested persons or groups are at low risk for TB and might not even be candidates for LTBI treatment. This testing often is required by regulations or policies created outside the TB control program.

^¶ Optional reporting fields.

Figure 1: Persons who sought, enlisted, or registered for targeted testing by treatment disposition

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Table 2: Persons diagnosed with latent TB infection, by risk type and by starting and completing treatment regimen

(N=14 reporting programs)

Table 2. Persons diagnosed with latent TB infection, by risk type and by starting and completing treatment regimen

	Targeted testing project medical risk*	Targeted testing project population risk†	Targeted testing individual medical risk*	Targeted testing individual population risk†	Administrative	Total
Latent TB infection	175	3,394	486	1,667	455	6,1771
Candidates for treatment	88	2,554	425	1,440	367	4,874
Started treatment	79	1,173	357	1,046	239	2,894
Completed treatment	31	977	281	796	167	2,252

Notes

Programs reporting include California, Los Angeles, San Diego, Florida, Georgia, Massachusetts, New Mexico, New York, New York City, North Carolina, Ohio, Virginia. And Washington.

^*Medical risk: Persons with latent TB infection who have a condition that has been associated with predisposition to TB disease, usually a concurrent medical diagnosis. Latent TB infection treatment has increased urgency for persons in this target category.

^† Population risk: Persons with latent TB infection who are members of socially or demographically defined groups that have been associated with high prevalence of TB infection or a high transmission rate.

¹ Please note that this total differs slightly from the total in Table 1. This is not an error but is a function of inconsistent reporting.

Table 3: Reasons patient stopped treatment for persons identified with latent TB infection through targeted testing who started treatment

(N=5 reporting programs)

Table 3: Reasons patient stopped treatment for persons identified with latent TB infection through targeted testing who started treatment

	Targeted testing project	Targeted testing individual	Administrative	Total
Patients stopping treatment (n)	38	269	53	360
Active TB developed	0	0	0	0
Adverse effect of medicine	5	25	3	33
Death	1	2	0	3
Patient chose to stop	3	70	20	93
Patient lost to follow-up	24	150	27	201
Patient moved (follow-up unknown)	3	9	2	14
Provider decision	2	13	1	16

Note

Programs reporting include California, Los Angeles, San Diego, Florida, New Mexico, New York City, New York (State), and Ohio.

Evaluation Indices, 2021

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