A Clinician’s Perspective
Improving Quality of Care for Patients Living with HIV and Aids Using the T-SPOT.TB test
The McGregor Clinic provides health services for medically needy and underserved persons living with HIV and AIDS within Lee County, Florida. Their catchment area is about 150 miles with limited public transportation. Because the McGregor Clinic provides primary care, the clinic staff also treats diabetes, hypertension, and other comorbidities and co-infections. Currently, about 750 patients ranging in age from 17 to 81 years old are being treated at the clinic. Of these, 51% are minorities and about 40% are women. Only 10% of the patients are privately insured; most have no insurance and receive their care through the Ryan White CARE Act, Medicaid, and/or Medicare.
Sharon Murphy, RN, ACRN, is the clinic’s executive director, and Jenna Hess is the clinic’s lab supervisor. Here they provide their perspectives on how using the T-SPOT.TB test has affected their ability to provide quality care at the McGregor Clinic.
Before adopting the use of the T-SPOT.TB test for TB screening, Sharon Murphy described their TB screening program as “hopeful.” She explains:
“We would place a TST and hope to see the patient again, but there were just so many barriers. We service a large immigrant population, many of whom don’t speak English, so communicating effectively about the test and the need for a return visit can be difficult, even though we do have translators on staff. In addition, many of our patients are unable to read, so they don’t know if they have been on TB medications in the past. Many of our patients rely on public transportation to get to our clinic and travel a long distance; having to come back 2 or 3 days later was not a high priority for them, and in some cases, just not possible. Our return rate was about 25%. Of those that came back to get a reading, about 50% were positive. Those people were then referred to the Health Department for treatment. We had patients who self-reported previous positive TSTs, but we weren’t confident that they remembered their medical history correctly, so we watched them closely for other issues. We also have patients who didn’t want a TST placed. For those we did cough assessments; however, those were unreliable too.
“My biggest issue with the TST was that we were missing people who needed to be in treatment. We’re in an epidemic here in Florida, because of our immigrant population and because people just aren’t entering into care. So, we’re seeing more and more infections come back that we thought were under control. Our patients are immunocompromised so it is important that we identify and treat TB infection and disease before it spreads. If we can identify even one patient with LTBI and prevent reactivation, we can reduce the exposure risk to others. Also, if we have their TB disease under control and their HIV in control we can return them to an optimal state of health. We don’t want to treat one infection and ignore the other and, without having clients return to have their TSTs read, that was what we were doing. We were treating the HIV but missing the elephant in the room and that elephant is TB infection. So using the TST just wasn’t working for us.
“Even though our primary concern for our TB screening program was patient compliance, we also needed to make sure that our staff were safe. Some of our staff have been working in the field for so long they would end up with positive TST reactions. They would have to undergo a chest x-ray and a symptom screen to make sure they did not have TB disease. Switching to the T-SPOT.TB test provides our staff with a reliable, accurate test for annual screening, and reduces our concern about exposure. TB is not something we want to bring home.
“We have found that using the T-SPOT.TB test has reduced our administrative time because we no longer have to track down patients to get the TST results. We get the results online within 36 hours and now our patient compliance is 100%. We screen all of our patients using the T-SPOT.TB test. We don’t have any gaps or misinformation from patient self-reporting.
“If the results are negative, we are confident that they don’t have LTBI. If the results are positive, we are able to refer them to the Health Department more quickly for follow-up. Patients are able to get appointments at the Health Department faster with a positive T-SPOT.TB test result than a positive TST result. The Health Department would retest the patients before beginning any therapy. Now they are using our T-SPOT.TB results as confirmatory and starting the patients on therapy sooner when needed.”
Using the T-SPOT.TB test has been a smooth transition for Jenna Hess, the lab supervisor at McGregor Clinic. She describes her experience with Oxford Diagnostic Laboratories:
“We typically draw blood from four to five patients a day for T-SPOT.TB testing. For our new patients, we draw blood for their T-SPOT.TB test on their second visit unless there is an identified risk. We can draw blood 5 days a week, which is a great change from only being able to place the TST 2 days a week, and we send the samples overnight to Oxford Diagnostic Laboratories.
“It has been wonderful working with Oxford Diagnostic Laboratories. Getting a quick response from a lab can sometimes be a challenge, but the customer service we receive from Oxford Diagnostic Laboratories is great. There is always a person to answer the phone and give us the information we need in a timely manner. They provide reliable, accurate service.
“Overall, Oxford Diagnostic Laboratories has helped us improve our service to our patients. The customer service we have received from them is translated to our patient care. It is great for us to be able to offer a great test, like the T-SPOT.TB test, to our patients and staff, but to compound that with great customer service for us is excellent, and it helps us provide better care for our patients.”
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