An assessment of nucleic acid amplification testing for active mycobacterial infection
Approach to assessment Objective
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Approach to assessmentObjectiveTo determine whether there is sufficient evidence, in relation to safety, effectiveness and cost-effectiveness, to have NAAT listed on the MBS for the diagnosis of MTB in patients with the signs and symptoms of active TB, and NTM in patients suspected of having an NTM infection. A systematic review (SR) of published medical literature was undertaken. Searches to identify relevant studies and reviews for the period between 1990 and June 2014 were conducted for the Cochrane Library, Current Contents, Embase, PubMed, Web of Science, Cinahl, Econlit and Scopus databases, as well as Australian and international health technology assessment (HTA) websites. Clinical pathwayThe clinical management algorithms for patients with the signs and symptoms of active TB are shown in Figure 3 and Figure 4. The pathways underwent public consultation and incorporated both expert opinion and guidance from the Centers for Disease Control9. There is a view by experts that the major factor in the current clinical management of a patient with the signs and symptoms of active TB is the patient’s pre-test probability of having TB. Figure 3 presents current and proposed clinical management algorithms for patients with the clinical signs and symptoms of active TB and for whom AFB microscopy can be done; that is, the patient can provide a sample for testing. This includes samples such as sputum, bronchoalveolar lavage, bronchial aspirates, gastric aspirates and stool for the diagnosis of pulmonary TB; and samples such as cerebrospinal fluid (CSF), urine, lymph node fine-needle aspirates (FNAs) or any other body fluid or tissue sample for the diagnosis of extrapulmonary TB. Currently, clinicians rely on the results of AFB microscopy, as well as whether the patient has a high or low pre-test probability that they will have active TB, as the basis to initiate or defer antibiotic treatment. NAAT is suggested as an adjunctive test that would be performed concurrently with AFB microscopy and culture. Figure 4 presents current and proposed clinical management algorithms for patients who present with the clinical signs and symptoms of active TB and from whom it is not possible to obtain a specimen suitable for AFB microscopy. The only patients that could be identified to fit this profile were those for whom it was not possible to obtain a sample for any purpose. Due to the lack of a sample, the effectiveness of NAAT is not assessible in these patients. Thus, this algorithm could not be addressed in the assessment and will not be discussed further. Figure 5 presents current and proposed clinical management algorithms for patients who are suspected of having an NTM infection. It should be noted that the NTM population eligible for NAAT has been expanded from the population specified in the protocol, in order to include patients presenting with specimens other than tissue biopsies, such as sputum specimens to be tested for MAC disease or blood samples for disseminated NTM. It should also be noted that histology is not able to differentiate between MTB and NTM infections and it is assumed that culture will also be performed. The expanded population base was necessary due to the insufficient evidence-base for NTM infections as a whole. The proposed use of NAAT will substitute for current testing. 
Figure 3 Current clinical management of TB and proposed use of NAAT for active TB where AFB is obtained Directory: internet internet -> Applications and limitations internet -> L. and Gossypium barbadense internet -> Natural Resources Conservation Service Conservation Practice Standard internet -> Practice Exercise Created By Stavros Charalambous The Internet internet -> It’s a good Topic internet -> National Preventative Health Strategy – the roadmap for action internet -> Downloading gps gr-3 Surveys Summary of Procedure internet -> 3G300m-how to setup the 3g router Mode? Product line: 3g question categories: Function configurations Note internet -> Installation Work has never been simpler or easier Download 12.08 Mb. Share with your friends:
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