title: Use of Nucleic Acid Amplification Tests in Tuberculosis Patients in California, 2010-2013.
abstract: BACKGROUND
  Nucleic acid amplification tests (NAATs) have been used as a diagnostic tool for tuberculosis (TB) in the United States for many years. We sought to assess NAAT use in TB patients in California during a period of time when NAAT availability increased throughout the world.
  
  
  METHODS
  We conducted a retrospective review of surveillance data from 6051 patients with culture-confirmed pulmonary TB who were reported to the California TB registry during 2010-2013.
  
  
  RESULTS
  Only 2336 of 6051 (39%) TB patients had a NAAT for diagnosis before culture results. Although 90% (N = 2101) with NAAT had positive test results, 9% (N = 217) had falsely negative NAAT results, and 0.8% (N = 18) had indeterminate NAAT results. The median time from specimen collection to TB treatment initiation was shorter when NAAT was used (3 vs 14 days,P< .0001), and patients with a positive NAAT result initiated treatment earlier than patients with a falsely negative result (1 vs 11 days from NAAT report,P< .0001). We confirmed the increased sensitivity of NAAT compared with acid-fast bacilli (AFB) smear microscopy in our study population; 92 of 145 AFB smear-negative patients had positive NAATs. Median time from specimen collection to NAAT result report differed by health jurisdiction, from 1 to 11 working days.
  
  
  CONCLUSIONS
  Increased use of NAATs in diagnosis of pulmonary TB could decrease the time-to-treatment initiation and consequently decrease transmission. However, differential use and access to NAAT may prevent full realization of NAAT benefits in California.
authors.affiliation: Present Affiliation: Acute Disease Epidemiology Section, Georgia Department of Public Health , Georgia.
authors.forename: Gianna
authors.initials: G
authors.lastname: Peralta
authors.affiliation: Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health , Richmond.
authors.forename: Pennan
authors.initials: P
authors.lastname: Barry
authors.affiliation: Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health , Richmond.
authors.forename: Lisa
authors.initials: L
authors.lastname: Pascopella
keywords: TB surveillance; United States.; diagnosis; treatment initiation