Risk-Based Targeted Tuberculosis Screening In Virginia

In January 1999, the Virginia Department of Health implemented a new tuberculosis (TB) screening policy that focuses efforts on persons at risk of TB infection or disease. Also, VDH established partnerships with statewide regulatory agencies to refine and revise TB screening requirements related to employment and facility licensure, and with student health services at Virginia Commonwealth University (VCU) to evaluate the accuracy of targeted screening in comparison to the traditional, universal approach.

The goal of the program is to optimize the efficient utilization of public health resources by targeting tuberculin screening activities to persons at increased risk for TB infection or disease.

Risk-based targeted tuberculin testing has been implemented 34 of the 35 local health districts in the Commonwealth of Virginia.
Between FY2000 and FY2002, there was a 39.8% (69,569 vs. 41,913 tests) decrease in the number of TSTs administered statewide. Thirty of the thirty-five local districts reported decreases in the number of tests administered.
As a consequence of this policy change, utilization of state-funded chest radiography services declined by 88%, resulting in an annual cost-savings of nearly $175,000 compared with FY 1998.
Over this same time period, the percentage of positive results among those tested increased from 3.4% to 6.1%, suggesting that the targeted testing policy has improved the efficiency of screening by preferentially removing those who would be TST-negative. This assertion is supported by data, published from a project carried out in collaboration with VCU Student Health Services.
Existing state regulations that establish TB screening requirements for school employees and social service agencies and facilities, including group homes, detention centers, and adult and child day care centers have been officially reinterpreted to allow risk assessment in lieu of tuberculin testing where applicable.