An assessment of nucleic acid amplification testing for active mycobacterial infection

Addressing the problem

Strategies and policies such as Closing the Gap¹⁸ and The Strategic Plan for Control of Tuberculosis in Australia: 2011–2015 are aimed at addressing the high Indigenous TB rates. Key priorities and actions for TB control that impact on Indigenous Australians include:

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  reducing the disparities in TB rates among population sub-groups within Australia
  
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  minimising the development of drug resistance within Australia
  
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  ensuring the continued provision of safe, timely laboratory diagnosis of TB
  
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  developing a strategy for awareness campaigns for primary care and organisations representing high-risk groups
  
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  developing a national strategy for long-term assured supply of quality TB diagnostics and medications.
  

Skilled clinical and laboratory staff and universal access to rapid and reliable diagnosis and treatment for TB are critical for the success of these measures^19. There are five state Mycobacterium Reference Laboratories in Australia, which provide basic TB diagnostic services (AFB microscopy and culture) as well as NAAT, DST, rapid molecular detection of drug resistance, and molecular epidemiological typing. These laboratories also provide specialised diagnostic services for the detection and characterisation of clinically significant NTM infections.

In providing these services, laboratories face increasing challenges such as the rising costs of providing a range of NAATs and compliance with progressively more stringent biosafety standards. Thus, the laboratories require the continued support of federal and state governments to remain an integral part of the nation’s TB control program. Currently, the cost of NAAT is mostly covered by state funding to the laboratories, but the availability of reimbursement for NAAT on the MBS would aid laboratories in maintaining the current high standard of the services provided. MBS reimbursement would also enable other public and private laboratories to offer NAAT in cooperation with the reference laboratories, which would provide training of laboratory personnel in mycobacterial diagnostics in both the public and private sectors. The broader availability of NAAT may result in more-rapid diagnosis and treatment of TB, leading to a further reduction in the spread of TB among close contacts in the community. This would benefit both the Indigenous and the immigrant populations.