There is a lot of confusion that surrounds TB tests. These types of tests are usually a part of compliance or if not, it is a regular test that a facility would require annually or every other year. Let me help you clarify some things that usually cause confusion when it comes to having a traveler being required to do a TB test. I would not of course advise having one take all types of tests for the sake of covering all bases. Facilities can be lenient and require just one test of any kind but on the other hand, a facility can be really specific to what they want within a given timeline which could be a total nuisance. My advice is go ahead and do the test, whichever is convenient for you at the time you have the chance and keep it for the record.
Moving forward, let us discuss the different types of tests and I will also share how often facilities request for these tests and what to watch out for.
PPD/Skin Tests
Now this is the most common test that is required by the facilities. A lot of agencies would prefer this too since this is the cheapest type of test that is available. Even facilities would usually have this type of test during annual exams for their employees therefore it will be no surprise that they will be requiring this for their travelers. Another good thing about a PPD is that results can be had as soon as 48 hours to 72 hours depending on the availability of the result for it to be read. Do note however that if the test is not read after 72 hours, the test will be considered void, and you will have to do the test all over again. I understand that a lot of people are not fans of the test because it’s also considered as the more painful type of tests compared to the other types. Another reason is because the results still had to be read after getting the test administered. This means that the candidate would usually have to go back to the clinic to have the results read and some travelers are too busy to make two trips to the clinic. Although some would opt to have their results to be read in the facility by another qualified nurse. All they have to do is make the necessary arrangements with the clinic so they can coordinate the results for their own record.
A facility then can require something called a two-step TB test. What this basically means are two PPDs in the span of a year. Rule of thumb is one test within the year of the target start date and the second one within 30 days of the start date. This is considered tedious and agencies would then consider other options most especially if you do not have an initial test within the year.
T-Spot
A lot of the agencies will be considering this as a second option for TB tests because most usually the facilities that would opt for the two-step TB test would end up agreeing to having T-Spots replace the two PPDs. The reason why this is not the first option is because this is usually twice as expensive as a PPD. Agencies would usually have the PPD as first option but have the T-Spot at the ready in case the first one is not viable. Another reason why T-Spot would usually end up as a secondary option is because they can take twice as long in waiting for the results. Unlike the PPD wherein you are assured the results in 48 to 72 hours, a T-Spot result can take up to 5 business days. A T-Spot is a blood draw and depending on how efficient the lab processing it is, you may be up for a wait if your agency opted for this test.
Q-Gold/Quantiferon
Like the T-Spot, this is also a blood draw. Now as far as agencies are concerned, this is not usually a part of the options they have when it comes to TB tests because even when we just found out that the T-Spot already is twice as expensive as a PPD, A Q-Gold can still be up to thirty percent more expensive than a T-Spot. Most of the time the only reason an agency would have a traveler do this type of test is that the facility specifically required this test. Another reason why this is not a very common option is that a test kit for a Q-Gold is not very common among clinics. One more thing, a lot of clinics confuse a T-Spot and a Q-Gold. You would think they are the same since they are both blood draws, but this specific test boasts a ninety seven percent (97%) specificity.
There is a vaccine usually administered to individuals outside the US called Baccile Calmette-Guerin (BCG) which renders the usual TB test useless since it could show a false positive result. This is very common, especially among Filipinos. So you ask yourself then, what can you do to prove you are clear for Tuberculosis if you got the BCG vaccine? This is the time when facilities would consider a chest X-ray (CXR).
Chest X-Rays
This is not a stand-alone test that facilities would be requiring. They might go back and forth with the first three discussed testing but never a CXR. The ONLY time a CXR is honored is when a traveler tests positive for the other test types. A facility would then be requiring a CXR result alongside a recent false positive result. Now the period of validity may vary according to different facilities. Most usually they can honor a CXR result within 2 years from the target start date.
Given these details regarding the different types of tests, it still boils down to the facility to decide which one they deem fit for their need. This is the reason why I also would like a two-week lead time when it comes to doing compliance/credentialing. A lot of factors would then have to be considered prioritizing whatever the facility needs. We have to be wary if and when the facility would actually require either one of the blood draw tests (Q-Gold or T-Spot) since they can take a while to complete. You can work closely with your agency compliance officer to find the right test for you. If you opt for the basic PPD test, make sure you have time to go back to the clinic for the reading of the results while on the other hand, if you had to do the blood draw, you also need time because the results can take a while to come back.
Whichever test you have currently on hand, it would be best to have them updated annually. For your next contract, check your compliance checklist to see if the test you have done is good enough.
