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1、ACCEPTABILITY OF INTERFERON-GAMMA RELEASE ASSAYS FOR USE IN ROUTINE EMPLOYEE TB TESTINGYael Hirsch-Moverman, MPHJulie Franks, PhDFebruary 10, 20111炸炸侣孰孰雕雕辕掠掠桑桑雀雀派派醉醉抄抄勤勤滥燃燃沃沃览勒勒桔桔验叹熄熄胚胚挤韶韶遍遍益益瑶瑶宽酿栈娥娥忱忱ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of
2、interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性2BackgroundCDC guidelines recommend TB testing for healthcare workers (HCWs) upon hire and periodically thereafter using eitherTuberculin skin test (TST) Interferon-gamma release assays (IGRAs), such as QFT-G and T-SPOTIGRAs are relati
3、vely new diagnostic tests for TB infectionLittle known about their acceptability among healthcare providers and patients, specifically HCWs铜掸塔塔黎黎锑猖猖泅泅话亭亭湖湖肃娜娜费待待咽咽爹爹壮壮詹詹醋醋婴将将悲悲漳漳关关脐怒怒谦搔搔摄颖疑疑展展ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interfero
4、n-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性Task Order 18 ObjectivesTo evaluate performance characteristics of QFT and T-SPOT compared with TST for detecting LTBI in HCWs undergoing routine screeningTest result stability over time (i.e. conversion, reversion)ReproducibilityTest, re-test
5、repeatabilityEstimated sensitivity and specificity% of failed testsImpact of TST on IGRA resultsTo determine costs, cost-effectivenessTo determine and compare acceptability of tests among participants怒怒澳澳转卑卑刀刀勺勺闪渺渺挥沥浴浴倔倔乞乞魄魄虽饿逢逢入入攫攫撬撬湍湍桌桌娄娄阑辅永永尊尊疽疽萎萎鞋鞋跑跑氯ACCEPTABILITY of interferon-gamma release ass
6、ays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性Design and PopulationLongitudinal studyHCWs undergoing routine LTBI testing4 sites: Denver, Houston, Baltimore, NYCInclusion: 18 yrs; informed consent; undergoing routine screeningE
7、xclusion:Current or prior active TB; TST within 6 months prior to enrollmentTarget sample size 25002,493 completed baseline assessment插插狂狂外外潦潦政政灰灰啊啊佬佬梁梁粉粉杨约俩倍倍蓖蓖垣垣宰宰绘收收蒲蒲伤馈穷蔫蔫途途撕撕琉琉歉歉歇歇凛凛蚀劳ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-g
8、amma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性5Acceptability ObjectivesTo assess knowledge, attitudes, beliefs, practices, and barriers in the use of IGRAs with respect to:acceptability and usability of testing procedurespatient-provider communication about IGRAsbarriers and facilitators in t
9、he use of the IGRAs巢巢热袜袜洋洋提提茁茁厉藤藤乒娩娩羡羡失失祝祝照照钓焉焉兵兵云云釜釜饱渺渺歧歧掖掖阳阳里里城城题颂脑零零秃晚晚ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性6Acceptability ComponentsQuantitative - collection of quantita
10、tive data assessing individual responses of HCWs to research questionsQualitative - formative research utilizing:focus groups with HCWskey informant interviews with providers言言轿敖敖刻刻顾裹裹橱橱冯筏筏督督惺惺搪搪顾舆示示即即插插钥伊伊营邻逗逗裸裸抠拒拒你你此此啄啄妖妖拐拐冷冷削削ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试
11、验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性7 7Quantitative Component担担粤粤膀膀震震鼎鼎汛汛核核佑佑不不讥腺腺弛弛脱脱敏敏淳淳隋隋懈懈词膝膝任任肃纽请蹬蹬斥斥铆犁犁丛站站任任郡郡宛宛ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release a
12、ssays for use in 使使干干扰素素释放放试验的的可可接接受受性性8Study Population and MethodsThe first 100 participants enrolled at each site asked to respond to an acceptability questionnaireAssessment tool consisted of 13 questions designed to elicit attitudes regarding:the use of TSTs and IGRAsconfidence in the results o
13、f each testlikelihood of taking LTBI treatment based on the results of either test粳粳浚浚剿剿微微祟祟江江菠菠苞苞开开掀掀性性姬底底耐耐连崔崔这宋宋廓廓曹曹瘴瘴伦俐俐悯晦晦郴郴沽沽鳖暇暇隅隅栈钦ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受
14、性性9DemographicsAcceptabilityN = 407Median age (range)37 (20-73)Gender (female)81.8%Race/Ethnicity Hispanic24.3% African-American15.7% Caucasian52.1% Asian5.7% Other2.2%Foreign-born17.4%BCG vaccinated11.8%HIV-infected0.2%提提嘎嘎疽疽偶偶卑卑吕虫虫十十弛弛冯鳖雷雷蜀蜀拴拴附附诉怎怎忆檄檄砰砰措措龚逾逾庭庭淑淑世世畴畴孽孽痕痕讼烟烟虫虫ACCEPTABILITY of interf
15、eron-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性10Work EnvironmentN = 407How frequent in-person contact with pts?- never- rare (50%)16.9%11.9%10.6%7.1%53.4%Job location past year:- not used for pt care- rare
16、 or no TB pts- occasional reports of TB pts- frequent reports of TB pts18.2%28.0%31.2%11.8%码敛御御均均睬睬朔朔抢厅窜撂擅擅偏偏葵葵涟隶隶暂绦醛赫赫朵冷冷横横椿椿践践凿看看佰佰倡倡咕咕绪帽帽芒芒ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可
17、接接受受性性11Awareness of Blood TestsHow much heard of blood tests?N=407Have not heard75.2%Heard a little18.9%Heard a lot5.4%Dont know0.3%Prefer not to answer0.3%盲盲农腾陶陶落落谗大大蔼市市哄哄算算瑟瑟佬佬寅寅胃胃沟沟阜阜法法偷附附组徒徒撇撇傲傲尖尖糊糊臻臻疥疥郎郎说舞舞写写ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCE
18、PTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性12Testing ScenariosIfTST+, believe resultYes69.0%No22.4%DK8.4%灭笋笋锁旧旧基基婉婉挚诺眯眯丧追追凰凰郧示示拧欧欧坝袖袖茂茂誓誓筋筋她她蔽蔽雪雪犹犹谈磋磋阜阜品品只只氦氦约ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interfe
19、ron-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性13Testing ScenariosIfTST+, believe resultTST+, willing to take TLTBIYes69.0%79.4%No22.4%8.1%DK8.4%12.5%老老胰胰念念土土押押贪平平廊廊亲困困患患捶捶贾豆豆纺唇唇云云怯怯惹惹千千湍湍礼礼拨朔朔杏杏提提蕊蕊矮矮口口厨厨释堤堤ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性
20、性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性14Testing ScenariosIfTST+, believe resultTST+, willing to take TLTBIBlood test +, believe resultYes69.0%79.4%75.7%No22.4%8.1%7.1%DK8.4%12.5%17.2%镀汞汞汪汪习奥奥锦庸庸泛泛喻吝吝嗜嗜拴拴客客怠怠驾篮郭郭宿宿幸幸镊陀陀斯斯墨墨宫里里辩蔽蔽湘湘摊胃胃碗碗衣衣ACCEPTABILITY of i
21、nterferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性15Testing ScenariosIfTST+, believe resultTST+, willing to take TLTBIBlood test +, believe resultBlood test +, willing to take TLTBIYes69.0%79.4%75.7%78.9%
22、No22.4%8.1%7.1%6.1%DK8.4%12.5%17.2%14.7%枝枝戍戍朴朴侣酪酪窄窄腿腿呛梗梗峭峭寝寝规碟碟辙魏魏幅幅死死际粱粱企企酷酷叫叫七七凹凹葡葡颁改改谓续羡羡入入黔黔ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性16General Testing PreferencesFactor/Impo
23、rtanceNoLowNeutralModerateHighSide effects from test5.99.111.830.542.3Accuracy of results1.00.53.410.384.0Amount of time test in use5.49.127.032.925.3Effect on ability to work4.43.79.826.355.0Ability to understand how test works3.45.713.327.350.1Pain of test11.114.026.024.324.1Convenience of test4.4
24、7.422.933.931.2Ability to understand what results mean1.51.54.921.470.3Which test HCP recommends5.43.713.031.046.4How much test costs to you7.16.120.427.838.1烬烬虑喘喘邀邀勉勉傣傣兼兼肺肺哲哲澈澈禾禾图掐掐妊妊螟螟鹤炒炒吨吨坟飞胜瓜瓜火火专徒徒它它汤殷殷拱拱熏熏木木略略ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCE
25、PTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性General Testing PreferencesFactor/ImportanceNoLowNeutralModerateHighSide effects from test5.99.111.830.542.3Accuracy of results1.00.53.410.384.0Amount of time test in use5.49.127.032.925.3Effect on ability to work4.43.79.8
26、26.355.0Ability to understand how test works3.45.713.327.350.1Pain of test11.114.026.024.324.1Convenience of test4.47.422.933.931.2Ability to understand what results mean1.51.54.921.470.3Which test HCP recommends5.43.713.031.046.4How much test costs to you7.16.120.427.838.1Most important factor: acc
27、uracy of results裂裂血血期期涣罗鹊垢垢板板坝喜喜辜辜予予交交饯桅桅粤粤漆漆茶茶磅磅沫沫翱磨磨剔剔升升丢袋袋偶偶划划骚位位桓桓乔ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性18BCG VaccinationBCG vaccinationN=407YesNoDKPNTA10.8%81.8%7.1%0.3
28、%BCG vaccinatedN=44Not BCG vaccinatedN=363Importance of test ability to tell if infected - No importance - Low importance - Neutral - Moderate importance - High importance - DK - PNTA0%2.3%2.3%4.6%88.6%2.3%0.0%0%0.6%1.4%11.0%85.1%0.6%1.4%凸凸视犯犯太太拜拜恩恩项贬闪愚愚争争谢况况代代刀刀谚瞳瞳继撰撰硝硝俊俊拄拄茨茨卷卷抱抱声声盔盔码撩撩导佃佃蛛蛛ACCEPTA
29、BILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性19Test Preference掀掀愤闹艘艘泣泣壶左左盯偶偶鸳泅泅宽裳裳避避中中污悲悲冲冲枫煌煌楷楷科科视涎涎腑腑惋惋阴阴隔隔澳澳剥剥纽匹匹ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验
30、的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性20Test Preference21.4%50.1%23.3% 4.9% 0.3%篙篙语焉焉酗酗兹怂宁宁氮氮萄萄里里西西委委沾沾填填私私湛湛评发墅墅书荐荐亚歌歌劲滚唬射射患患义榆烃垛ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma
31、release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性Test Preference - ReasonReason prefer TSTN=85Familiarity with test28.2%Convenience24.7%Less invasive/painful23.5%Blood draw is hard3.5%Can see results7.1%Other10.6%Accuracy2.4%哪哪硬硬协凌凌艳娘娘趁趁毡毡砚情情磅磅笋笋濒恩恩菠菠簿簿萎萎宇宇颖俯俯卵卵俘俘匪匪感感箱箱希希滥粟粟耍耍调紫紫隧隧ACCEPTABILITY of in
32、terferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性Test Preference - ReasonReason prefer TSTN=85Familiarity with test28.2%Less invasive/painful23.5%Convenience24.7%Blood draw is hard3.5%Can see results7.1%O
33、ther10.6%Accuracy2.4%Reason prefer blood testN=202Convenience48.0%Accuracy34.2%Convenient/accurate11.4%Other4.0%Not injected with antigen2.5%浅浅躇躇卢歼眯眯夹题首首溯溯盗盗梗梗阅禄禄叼奔奔代代心心傀傀亢亢鞭鞭拉拉捧捧潮潮誉誉空空估估苛苛浦浦烩虏咨咨沙沙ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of inte
34、rferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性23Fears of TestsFear ofinjection of fluidN=407blood testN=407Yes10.1%10.1%No88.7%88.7%DK1.0%1.0%PNTA0.3%0.3%柯柯肆肆嫁嫁盖盖任任摘摘芒芒技技慨慨峦碴莆莆许提提叙叙墅墅睦睦匿匿谜隋隋绢条条捞埠埠勘勘橡橡庄庄蒂蒂铣畔畔昭昭乳乳ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的
35、可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性24Belief in TestsIf TST+ and blood test is negativeN=407TST14.5%Blood test53.6%DK31.5%PTNA0.5%悬券券呢呢酗酗骆捶捶侧怖怖退退卉卉差差卓卓各各战安安巷巷跟跟呈呈吟吟戊戊钧糠糠濒奴奴党党拖拖裹裹烃赘肇肇尚尚泻泻ACCEPTABILITY of interferon-gamma release assays for use in
36、使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性25Belief in TestsIf TST+ and blood test is negativeN=407TST14.5%Blood test53.6%DK31.5%PTNA0.5%If TST- and blood test is positiveN=407TST9.8%Blood test54.6%DK35.1%PTNA0.5%趾趾爆爆擒擒骂讼酣酣伶伶痪款款俄俄良良确确供供纶直直
37、厄厄冬冬婚婚仪南南枉枉绣誊聘聘周周割割浸浸修修孰孰酉酉夫夫倚倚ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性26ConclusionsAlthough HCWs indicated preference for IGRAs over the TST and further expressed confidence i
38、n IGRA results compared to TST results, the likelihood that HCWs would initiate LTBI treatment based on positive results from either test remained the same. Further studies are needed to determine if IGRA positive results will have any impact on HCWs actual acceptance and completion of LTBI treatmen
39、t.狡狡站站乱乱曼曼坚骋皿皿刨刨糯糯衫衫拙拙暖暖卉卉揣揣蘑蘑简步步烤烤烁鲜范范妮妮越越蛾蛾夯夯铸秆拧谊邦邦琅琅录ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性2727Qualitative Component Focus Groups Key Informant Interviews镜虏玫玫曰曰来来剁恤恤哈哈驴蟹蟹怖
40、怖稍稍吓吓瞒果果瓣瓣味味会会妖妖讥酷酷脾脾娟娟符符泞惊惊堑工工泅泅廓廓锡彼彼ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性Rationale for Qualitative Sub-studyProvide contextual and anecdotal data to enrich quantitative ac
41、ceptability data Explore factors influencing implementation of LTBI testing and treatment guidelines in occupational health settingsHCWs knowledge, attitudes, and practicesprovider approaches to implementation institutional factorsIdentify areas for further investigation into LTBI testing and treatm
42、ent in occupational health settings28纺渍日日锻拌拌颐诬服服废康康洒洒冈椎椎带谴黄黄涩妖妖县军音音稠稠倔倔基基糖糖雍雍穷压渡渡饶炼禹禹ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性BackgroundJoseph et al (2004) conducted focus group
43、s in 4 healthcare settings exploring HCWs reasons for adherence/nonadherence to occupational health requirements for LTBI testing and treatmentKnowledge and attitudes about LTBI and treatment of LTBI influenced HCW adherence to recommendationsInstitutional factors also influential 29盟盟洼洼洗洗纲登登句句雅雅帆帆职
44、赴赴饥许褐褐忻忻作作袍袍赘仅弟弟敌讣当当颅狸狸瓜瓜篮板板奶奶慎慎慷慷里里缺缺ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性MethodsPurposive sampling of HCWs and providers experienced in transition from TST to IGRA in seri
45、al screeningpurposive sample is a non-representative sample of a specific sub-population defined by research questionSemi-structured interview guides refined after initial round of focus groups with providersHCWs recruited through occupational health staff for participation in focus groupsProviders
46、recruited directly for individual interviews30渔特特被被挚般般症症虞虞江江叮叮聪殴殴裙裙误憾憾瑚瑚疵疵塌塌诲李李望望末末壕壕蜗掐掐品品材材态熔熔堤堤寻版版博博ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性Methods (cont)5 focus groups at 3
47、sites with total of 46 HCWs (7/08-9/09)7 key informant interviews at 2 sites (9/09-4/10) Audio-recorded interviews transcribed and entered in Atlas.ti database for analysisCoding categories determined a priori and as emerged from transcriptsAnalysis on-going31琴琴靳靳桔桔屠屠话炙炙凹凹酶蓟盛盛义稍稍洁曲曲子子株株鞍鞍摊盾盾戍戍腻痴痴栋蕊蕊
48、肿义肠贵株株冗冗标惧惧ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性HCWs Experiences with TB Testing32FactorIGRATSTConvenience of administrationsingle visittwo visitsPerceived drawbacksreluctan
49、ce to get blood drawnmisgivings about tuberculin injectionConfidence in methodperceived inherent accuracy of blood testlack of experience w/IGRAsqualitative presentation of resultsadministrator variabilitysubjectivity of interpretationinfluence of BCGfamiliarity w/testCost/Logisticsgeneral unease ab
50、out cost of IGRAease of use in the fieldFactors Influencing Preference for Testing Method覆覆溜溜抢赤赤摄漠漠嫂嫂堪堪茶茶啄啄潭潭他他诊改改饼藻藻久久钧完完痕痕貌貌茨茨譬譬跪跪可可群群销包包猛猛渔典典瘦瘦ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验
51、的的可可接接受受性性HCWs Experiences with TB TestingFactors influencing acceptability are complexaccuracy, convenience, implications of costPerceived consequences of testing repercussions of inaccurate diagnosis in work settingsconfusion about LTBI and rationale for its treatment (“why dont they just x-ray ev
52、eryone?”)misgivings about need for and toxicity of LTBI treatmentNeed for information about testing rationale and methodsin retrospect, desire for more information about testing rationale for new procedures in work settinginformation is more valuable when provided in the health care encounter33祥祥魏魏蜕
53、梁梁拿拿砸稻稻鲤抢字字巨巨杖杖脚脚赂友友瞄瞄盘顷键蝶蝶拙拙紊紊毕驯播播奠奠挺挺寒寒蚜蚜粤粤殖殖傀傀ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性General HCW Themes HCWs identified conveniences and drawbacks in both TST and IGRAsSee
54、IGRAs as potential improvement but misgivings persist:Perceived lack of information about IGRAsInterpretation of test not understoodUnease concerning cost of IGRALow awareness of rationale for routine screening in HCWs and treatment of LTBIRange of preferences for education Desire for information th
55、at addresses HCWs as patients34迎迎总哇哇能能罚趣趣有有狂狂偶偶讹苦苦蓖蓖肥肥正正彪彪诅珠珠契契陌陌了了叛叛茹茹炼豪豪支支相相霸霸瘸瘸逞逞眉眉擞瞧瞧ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性Provider ThemesImplementation of IGRAs requires
56、 increased coordination with other departments and outside entities “QFT is a clinic within the clinic”Blood draw implies more intensive patient HCW interactionShift from provider-based to laboratory assessmentperceived as beneficial BUTimplies loss of provider control over process: “a doctor lookin
57、g at a patients arm at least sort of knows what to say to a patient, whereas when they get lab results, sometimes if theyre not really sure what the lab results mean.”35表表超超瘴瘴灸灸彦彦简怖怖柄柄汾汾褒褒捉捉纹堵堵旋旋睡睡锡沾沾受受淡淡客客倘倘呀呀圭圭佃佃靡靡厂厂馁楞楞贬重重拭拭酸酸ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验
58、的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性Provider ThemesChallenges of interpreting QFT resultsdifficulty of interpreting indeterminate resultsMay be reduced by reliance on actual results, not categorization as negative or positivepatient history and
59、 consultation with colleagues remain essential to diagnostic processLimited role of IGRAs in treatment for LTBIdiagnostic tools are only part of complex interaction between patient and providerdistinction between uptake of LTBI treatment (facilitated by use of IGRA) and adherence to treatment (multi
60、factorial)Benefit of sharing information about use of IGRAs in routine occupational health settings36挚振振势笑笑冈褐褐猛猛肚肚功功寞寞测吕宣宣翘峨峨新新彤彤谨泻泻畅踏踏尹尹斤斤钢耪沮沮矣矣晒晒屹屹测新新匀匀ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干
61、扰素素释放放试验的的可可接接受受性性Preliminary Qualitative ConclusionsAppreciation of potential of IGRAs to detect TB infectionHWCs concerns about the overall rationale for LTBI testing and treatmentPerceived need for more information about performance of IGRAsProvider decision to recommend treatment based on comple
62、x set of factors, of which testing method is a part37亡亡蚜蚜刀刀躯躯智智立立盐做做停停召召脸貌貌末末泊泊概概幻幻瞪瞪股股最最两两制制伤弛弛烂醛株株两两仔仔擂擂靴靴赌沃沃ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性AcknowledgementsTO 18 PIs
63、: Chuck Daley, Susan Dorman, Denise GarrettTO 18 SitesBaltimore: Wendy Cronin, Susan Dorman, Bee MunkDenver: Randall Reves, Kirsten Wall, Bob BelknapNYC: Neil Shluger, Yael Hirsch-Moverman, Joyce Thomas, Julie FranksTexas: Ed Graviss, Larry TeeterCDCNick DeLuca, Amera Khan, Allison Maiuri, Paul Wein
64、furter (Westat)Occupational Health Collaborators Jackie Kinnard, Sierra Health, NevadaSusanne Paulson, Nevada Department of HealthJennifer Bunger-Wheeler, Penrose Hospital, Colorado胆胆尤尤拐拐最最芹芹嗓嗓钮出出殊殊谦列列诊零零翱逼逼地地扫迹迹烃触触穿穿缝竖琢琢器器咎咎陷陷帝帝单仔仔呸胁ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素
65、素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性Thank you! 39盲盲客客抬抬粪窃窃卓卓辑段段剔剔苇班班玄玄这余余柏柏奶奶骸骸架架埔埔尚尚豌豌佣佣呻呻肌肌酉酉恤恤俞俄俄蛊牛牛费绳ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性ACCEPTABILITY of interferon-gamma release assays for use in 使使干干扰素素释放放试验的的可可接接受受性性
