Repeat Interferon γ Release Assay Use in US Community Healthcare Organizations
Abstract
Background: Interferon γ release assays (IGRAs) are the preferred test for tuberculosis infection in the United States. Their results can fluctuate from positive to negative (reversion), but there is limited information about who does or should receive repeat testing in routine clinical care.
Methods: We performed a retrospective cohort study of all individuals with a positive IGRA result in a US community health organization network (OCHIN). We characterized the frequency and predictors of repeat testing and reversion. We used published recommendations to classify repeat IGRAs as “likely,” “possibly,” and “probably not” indicated, and we estimated repeat IGRA overuse and underuse.
Results: Among 65 728 individuals with a positive IGRA result, 8978 (13.7%) had ≥1 subsequent test. Of the 8174 second tests with full results available for analysis, 6176 (75.6%) remained positive, 1904 (23.3%) reverted to negative, and 94 (1.2%) were uninterpretable. Lower odds of reversion were associated with higher initial Antigen minus Nil (Ag-Nil) value (adjusted odds ratio, 0.38 [95% confidence interval, .32–.45] for Ag-Nil 0.70 to <1.00, and 0.06 [.05–.07] for Ag-Nil ≥1.00 vs 0.35 [vs Ag-Nil 0.35 to <0.70 IU/mL]), and birth in a country with versus birth in a country without elevated tuberculosis incidence (adjusted odds ratio, 0.59 [95% confidence interval, .52–.67]). Of all repeat tests, 40.0% were likely indicated, 9.0% were possibly indicated, and 51.0% were probably not indicated.
Conclusions: Approximately 1 in 7 individuals with positive IGRA results had repeat testing. Most repeat tests were probably not indicated according to our utilization classification, whereas nearly half of individuals without a repeat test may have benefited from one.
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BibTeX
@article{campbell2026repeat,
title = {{Repeat Interferon γ Release Assay Use in US Community Healthcare Organizations}},
author = {Jeffrey I Campbell and Meredith B Brooks and Leonardo Martinez and Matthew Murrill and Pranay Sinha and Emily Martey and Sophia Giebultowicz and Jenine Dankovchik and Angelica Falkenstein and Rachel Epstein and Jonathan Bressler and Heather Angier and Jessica E Haberer and Cynthia A Tschampl and C Robert Horsburgh and Helen E Jenkins and Karen R Jacobson},
journal = {Open forum infectious diseases},
year = {2026},
month = oct,
doi = {10.1093/ofid/ofag672},
url = {https://europepmc.org/article/PMC/PMC13728668},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Repeat Interferon γ Release Assay Use in US Community Healthcare Organizations
AU - Jeffrey I Campbell
AU - Meredith B Brooks
AU - Leonardo Martinez
AU - Matthew Murrill
AU - Pranay Sinha
AU - Emily Martey
AU - Sophia Giebultowicz
AU - Jenine Dankovchik
AU - Angelica Falkenstein
AU - Rachel Epstein
AU - Jonathan Bressler
AU - Heather Angier
AU - Jessica E Haberer
AU - Cynthia A Tschampl
AU - C Robert Horsburgh
AU - Helen E Jenkins
AU - Karen R Jacobson
PY - 2026
DA - 2026/10/10
JO - Open forum infectious diseases
DO - 10.1093/ofid/ofag672
UR - https://europepmc.org/article/PMC/PMC13728668
AB - Background: Interferon γ release assays (IGRAs) are the preferred test for tuberculosis infection in the United States. Their results can fluctuate from positive to negative (reversion), but there is limited information about who does or should receive repeat testing in routine clinical care. Methods: We performed a retrospective cohort study of all individuals with a positive IGRA result in a US community health organization network (OCHIN). We characterized the frequency and predictors of repeat testing and reversion. We used published recommendations to classify repeat IGRAs as “likely,” “possibly,” and “probably not” indicated, and we estimated repeat IGRA overuse and underuse. Results: Among 65 728 individuals with a positive IGRA result, 8978 (13.7%) had ≥1 subsequent test. Of the 8174 second tests with full results available for analysis, 6176 (75.6%) remained positive, 1904 (23.3%) reverted to negative, and 94 (1.2%) were uninterpretable. Lower odds of reversion were associated with higher initial Antigen minus Nil (Ag-Nil) value (adjusted odds ratio, 0.38 [95% confidence interval, .32–.45] for Ag-Nil 0.70 to <1.00, and 0.06 [.05–.07] for Ag-Nil ≥1.00 vs 0.35 [vs Ag-Nil 0.35 to <0.70 IU/mL]), and birth in a country with versus birth in a country without elevated tuberculosis incidence (adjusted odds ratio, 0.59 [95% confidence interval, .52–.67]). Of all repeat tests, 40.0% were likely indicated, 9.0% were possibly indicated, and 51.0% were probably not indicated. Conclusions: Approximately 1 in 7 individuals with positive IGRA results had repeat testing. Most repeat tests were probably not indicated according to our utilization classification, whereas nearly half of individuals without a repeat test may have benefited from one.
SN - 2328-8957
ER -