Quality statement 3: Rapid diagnosis of pulmonary tuberculosis

Quality statement

People who are referred to a tuberculosis (TB) service, who meet specific criteria, have rapid diagnostic nucleic acid amplification tests (NAATs).

Rationale

Diagnostic test accuracy and time to diagnosis or treatment initiation are critical for decision-making. Using NAATs significantly reduces the time to identify pulmonary M. tuberculosis and rifampicin resistance. Delayed diagnosis can delay the start of treatment, which may in turn lead to greater risks of morbidity (both long and short term) and mortality.

Quality measures

Structure

Evidence of local arrangements to ensure that people who are referred to a TB service, who meet specific criteria, have rapid diagnostic NAATs.

Data source: Local data collection.

Process

a) Proportion of people referred to TB services, who are aged 15 years or younger, who have rapid diagnostic NAATs to detect M. tuberculosis complex in primary respiratory specimens.

Numerator – the number in the denominator who have rapid diagnostic NAATs to detect M. tuberculosis complex in primary respiratory specimens.

Denominator – the number of people who are referred to TB services who are aged 15 years or younger.

Data source: Local data collection.

b) Proportion of people with HIV referred to TB services, who have rapid diagnostic NAATs to detect M. tuberculosis complex in primary respiratory specimens.

Numerator – the number in the denominator who have rapid diagnostic NAATs to detect M. tuberculosis complex in primary respiratory specimens.

Denominator – the number of people with HIV who are referred to TB services.

Data source: Local data collection.

c) Proportion of people referred to TB services, who are identified as having risk factors for multidrug resistance, who have rapid diagnostic NAATs to detect rifampicin drug resistance in primary respiratory specimens.

Numerator – the number in the denominator who have rapid diagnostic NAATs to detect rifampicin drug resistance on primary respiratory specimens.

Denominator – the number of people who are referred to TB services who are identified as having risk factors for multidrug resistance.

Data source: Local data collection.

Outcome

Proportion of people with pulmonary TB starting treatment within 2 months of symptom onset.

Data source: National and regional data on the proportion of pulmonary TB cases starting treatment within 2 months of symptom onset is collected in Public Health England's TB Strategy monitoring indicators.

What the quality statement means for different audiences

Service providers (laboratory services) perform rapid diagnostic NAATs on primary respiratory specimens for people who are referred to TB services, who meet specific criteria.

Healthcare professionals (such as nurses, secondary care doctors, specialists and paediatricians) request rapid diagnostic NAATs on primary respiratory specimens for people who are referred to TB services, who meet specific criteria.

Commissioners (clinical commissioning groups) ensure that they commission services that can do rapid diagnostic NAATs on primary respiratory specimens for people who are referred to TB services, who meet specific criteria.

People who are suspected as having pulmonary TB and meet specific criteria, have a sample of sputum that they have coughed up from the lungs, which is tested using a type of test that can quickly confirm if they have TB.

Source guidance

Tuberculosis (2016) NICE guideline NG33, recommendations 1.3.3.1, 1.3.4.1, 1.3.4.2 and 1.4.1.1

Definitions of terms used in this quality statement

Specific criteria

The specific criteria are that there is clinical suspicion of pulmonary TB and:

  • the person is aged 15 years or younger or

  • the person has HIV or

  • the person has had a risk assessment that identifies risk factors for multidrug resistance or

  • rapid information about mycobacterial species would alter the person's care.

[NICE's guideline on tuberculosis, recommendations 1.3.3.1, 1.3.4.1, 1.3.4.2 and 1.4.1.1]

NAAT

A test to detect fragments of bacterial nucleic acid, allowing rapid and specific diagnosis of M. tuberculosis directly from a range of clinical samples.

[Adapted from NICE's full guideline on tuberculosis (glossary)]