4-PA DOH TB Risk Assessment.pdf

This is a Tuberculosis (TB) Risk Assessment tool document developed by the Pennsylvania Department of Health (PA DOH) for use by healthcare providers to identify asymptomatic adults who require TB testing. The tool serves as a clinical screening instrument designed to standardize TB risk assessment practices across the state and help providers determine which patients warrant testing based on specific epidemiological and medical risk factors. The assessment identifies three primary risk categories: birth, travel, or residence in a country with elevated TB rates for at least one month (excluding the United States, Canada, Australia, New Zealand, and western or northern European countries); current or planned immunosuppression including HIV infection, organ transplant status, TNF-alpha antagonist treatment, high-dose steroid therapy, or other immunosuppressive medications; and close contact with someone with infectious TB disease during the patient's lifetime. The tool is not intended for repeat testing unless new risk factors have emerged since the previous test, and providers are instructed not to initiate TB infection treatment until active TB disease has been excluded through appropriate diagnostic workup including chest x-rays, symptom screening, and nucleic acid amplification testing when indicated.

The document emphasizes that a negative interferon gamma release assay or tuberculin skin test does not exclude active TB disease, and providers are required to conduct comprehensive evaluation for symptomatic patients or those with abnormal chest x-ray findings consistent with active TB. An interferon gamma release assay is preferred over a tuberculin skin test for non-U.S. born persons aged two years and older. The tool includes fields for recording patient name, date of birth, provider name, and assessment date. The PA DOH references an accompanying Pennsylvania Adult TB Risk Assessment User Guide available on the state health department website for additional implementation guidance and a comprehensive list of medical risk factors for TB disease progression. The assessment tool was adapted from the California Tuberculosis Control Association's risk assessment instruments and is intended to optimize resource allocation by allowing prioritization of testing within high-risk groups when resources are constrained.