Purpose
Tuberculosis (TB) programs report results of their targeted testing activities to CDC by entering the data into the Aggregate Reports for Tuberculosis Program Evaluation (ARPE) form through the National Tuberculosis Indicators Project (NTIP) performance-monitoring tool. This report summarizes targeted testing data, including treatment outcomes, from efforts in 2022.
About the Report
Background
Targeted testing for tuberculosis (TB) is a strategy to diagnose and treat latent TB infection among persons who are at risk of developing TB disease. Treating latent TB infection supports U.S. TB elimination goals through preventing TB disease and stopping the spread of TB to others. Longstanding, untreated latent TB infection accounts for approximately 80% of the TB cases in the United States.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 2022. 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 2022 would have until December 2023 to finish treatment, and the data would then be reported in 2024.
TB programs report aggregate targeted testing data in the following categories:2
Projects
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.
Referral
Referral data include testing of people who were referred to the health department because of possible latent TB infection.
Reporting states and cities
The following states and cities reported targeted testing data in 2022: California, Florida, Georgia, Illinois, Los Angeles, Massachusetts, New Jersey, New York, New York City, North Carolina, San Diego, Texas, and Virginia.
In addition, the following TB programs with <150 cases optionally reported targeted testing data for 2022: Alabama, American Samoa, San Francisco, Baltimore, New Mexico, and Houston.
Data from some reporting areas was incomplete and the number of programs reporting varies by table, leading to differences in overall numbers between tables.
Data summary
In 2022, 60,068 persons were sought, enlisted, registered, or referred for targeted testing, and 57,223 (95.3%) of those persons were evaluated for TB infection (Table 1). The targeted testing form allows optional reporting of U.S.–born or non-U.S.–born status as well as the use of Interferon Gamma Release Assay (IGRA) blood test or a Tuberculin Skin Test (TST). Of the persons identified for targeted testing, 24,236 persons were optionally reported as U.S.-born and 14,889 persons reported as non-U.S.-born. For the optional testing data, 42,405 persons were tested with an IGRA and 5,169 persons were tested with a TST, although reported use of these tests was not mutually exclusive. Of the persons evaluated, 8,973 (15.7%) were diagnosed with LTBI and 66 (<0.1%) were diagnosed with TB disease.
Most persons diagnosed with LTBI were considered candidates for LTBI treatment (7,004; 78.1%) with 3,188 (45.5%) of those candidates starting treatment (Table 2). Of the candidates who started LTBI treatment, 2,185 (68.5%) completed their treatment (Figure 1).
Fifteen TB programs optionally specified reasons for why 424 patients did not complete LTBI treatment (Table 3). About half of the patients did not complete LTBI treatment because they were lost to follow-up (50.5%). Other reported reasons for patients not completing treatment included patient choosing to stop (31.4%), adverse effect of the medicine (8.5%), unknown follow-up due to the patient moving out of the reporting TB program’s jurisdiction (6.8%), provider deciding to stop patient’s treatment (2.1%), and patient’s death during treatment (0.7%). No patients reportedly stopped LTBI treatment due to developing TB disease (0%).
TB program performance on specific targeted testing activities is summarized by targeted testing categories and LTBI risk types in Tables 4 and 5.
Targeted testing, 2022
Table 1: Persons sought, enlisted, or registered for targeted testing
(N=19 reporting programs)
| Targeted Testing Category | Total | ||||
|---|---|---|---|---|---|
| Projects | Individual* | Administrative* | Referral* | ||
| Persons sought, enlisted, registered, or referred for targeted testing | 39,265 | 16,207 | 4,061 | 535 | 60,068 |
|
23,408 | 632 | 125 | 71 | 24,236 |
|
6,247 | 8,209 | 60 | 373 | 14,889 |
| Persons Evaluated | 37,856 | 15,159 | 3,701 | 507 | 57,223 |
|
4,793 | 217 | 57 | 102 | 5,169 |
|
30,844 | 10,699 | 804 | 58 | 42,405 |
| Persons Diagnosed | 3,413 | 2,515 | 414 | 2,697 | 9,039 |
|
4 | 40 | 17 | 5 | 66 |
|
3,409 | 2,475 | 397 | 2,692 | 8,973 |
Abbreviations: TST, tuberculin skin test; IGRA, interferon gamma release assay blood test; TB, tuberculosis.
Reported data about use of TST or IGRA were not mutually exclusive.
Counts in this table are inconsistent due to missing data submitted to CDC.
See ARPE Targeted Testing and Treatment Form and Instructions for more details about the targeted testing category and risk groups.
* Indicates optional field for data submission.
Table 2: Treatment initiation and completion of persons diagnosed with latent TB infection by risk type
| Diagnosed with latent TB infection (n = 8,973) |
Candidate for latent TB infection treatment (n = 7,004) |
Started latent TB infection treatment (n = 3,188) |
Completed latent TB infection treatment (n = 2,185) |
|
|---|---|---|---|---|
| Targeted testing projects | ||||
|
230 | 140 | 117 | 83 |
|
3,179 | 2,275 | 1,152 | 918 |
| Individual targeted testing* | ||||
|
476 | 360 | 277 | 186 |
|
1,999 | 1,654 | 1,059 | 697 |
| Administrative targeted testing | 397 | 283 | 177 | 97 |
| Referral testing* | ||||
|
91 | 13 | 39 | 12 |
|
2,584 | 2,279 | 367 | 192 |
|
17 | 0 | 0 | 0 |
Counts in this table are inconsistent due to missing data submitted to CDC.
See ARPE Targeted Testing and Treatment Form and Instructions for more details about the targeted testing category and risk groups.
* Indicates optional field for data submission.
Notes for Table 2A
Figure 1: Reported Treatment Disposition of Targeted Testing Patients Diagnosed with Latent TB infection
Data in this figure were submitted by 19 programs Alabama, American Samoa, California (excluding Los Angeles, San Diego, and San Francisco), Los Angeles (CA), San Diego (CA), San Francisco (CA), Florida, Georgia, Illinois (excluding Chicago), Baltimore (MD), Massachusetts, New Jersey, New Mexico, New York (excluding New York City), New York City (NY), North Carolina, Houston (TX), Texas (excluding Houston), and Virginia. Treatment disposition was not reported for all cases.
Table 3: Reason treatment was not completed by patients who started treatment for latent TB infection
| Targeted Testing Category | Total (n = 424) |
||||
|---|---|---|---|---|---|
| Projects | Individual* | Administrative* | Referral* | ||
| Developed TB disease* | 0 | 0 | 0 | 0 | 0 |
| Adverse effect of medicine* | 7 | 27 | 2 | 0 | 36 |
| Death* | 2 | 1 | 0 | 0 | 3 |
| Patient chose to stop* | 15 | 96 | 20 | 2 | 133 |
| Patient lost to follow-up* | 44 | 156 | 10 | 4 | 214 |
| Patient moved (follow-up unknown)* | 7 | 21 | 1 | 0 | 29 |
| Provider decision* | 1 | 6 | 2 | 0 | 9 |
Counts in this table are inconsistent due to missing data submitted to CDC.
See ARPE Targeted Testing and Treatment Form and Instructions for more details about the targeted testing category and risk groups.
* Indicates optional field for data submission.
Evaluation Indices, 2022
Table 4: Percentage of persons evaluated and diagnosed by targeted testing
| Targeted Testing Category | |||
|---|---|---|---|
| Projects | Individual* | Administrative* | |
| Evaluation of persons sought, enlisted, or registered | 96.4% | 93.5% | 91.1% |
| TB diagnosis of persons evaluated | 0.01% | 0.3% | 0.5% |
| Latent TB infection diagnosis of persons evaluated | 9.0% | 16.3% | 10.7% |
Percentages were calculated using available data submitted to CDC.
See ARPE Targeted Testing and Treatment Form and Instructions for more details about the targeted testing category and risk groups.
* Indicates optional field for data submission.
Table 5: Targeted testing evaluation indices for persons identified with latent TB infection, by risk type
| Targeted testing projects | Individual targeted testing* | Administrative targeted testing* |
|||
|---|---|---|---|---|---|
| Medical risk |
Population risk | Medical risk* | Population risk* | ||
| Candidates for treatment of person diagnosed with latent TB infection | 60.9% | 71.6% | 75.6% | 82.7% | 71.3% |
| Treatment started by patients who are candidates for treatment | 83.6% | 50.6% | 76.9% | 64.0% | 62.5% |
| Treatment completed by patients who started treatment | 70.9% | 79.7% | 67.1% | 65.8% | 54.8% |
Percentages were calculated using available data submitted to CDC.
See ARPE Targeted Testing and Treatment Form and Instructions for more details about the targeted testing category and risk groups.
* Indicates optional field for data submission.
Resources
- Data in this table were submitted by 19 programs: Alabama, American Samoa, California, Los Angeles, San Diego, San Francisco, Florida, Georgia, Illinois (excluding Chicago), Baltimore, Massachusetts, New Jersey, New Mexico, New York, New York City, North Carolina, Houston, Texas, and Virginia. Counts in this table are inconsistent due to missing data submitted to CDC. * 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. ‡ Persons referred for administrative evaluation often is evaluated for latent TB infection treatment, diagnosed with a positive TST or IGRA, and cannot be counted as part of the other targeted testing categories. This category can include persons with latent TB infection who had their treatment delayed beyond a reporting period after they were evaluated or contacts who cannot be counted under the treatment categories in the ARPE Follow-up and Treatment of Contacts of TB report.
- CDC. Latent TB infection in the United States – Published Estimates. Centers for Disease Control and Prevention; 2024.
- Centers for Disease Control and Prevention. Aggregate Reports for Tuberculosis Program Evaluation: Targeted Testing and Treatment for Latent Tuberculosis Infection Form and Instructions. Centers for Disease Control and Prevention; 2021. /tb-programs/php/arpe/targeted-testing-form.html
- Programs reporting for non-optional reporting fields include Alabama, American Samoa, California, Los Angeles, San Diego, San Francisco, Florida, Georgia, Illinois (excluding Chicago), Baltimore, Massachusetts, New Jersey, New Mexico, New York, New York City, North Carolina, Houston, Texas, and Virginia. * 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 latent TB infection. The testing is often done at a health department clinic. ‡ Targeted testing administrative: Testing for latent TB infection 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 latent TB infection treatment. This testing often is required by regulations or policies created outside the TB control program. § Referral testing: If persons have latent TB infection that is diagnosed during other types of testing programs (e.g., applicants screening for permanent resident status adjustment by the civil surgeons) and they are referred to the health department for other testing and for treatment, they should be counted under the second half of this report, Referral Counts. ¶ Optional reporting fields.