FAST implementation in Bangladesh: high frequency of unsuspected tuberculosis justifies challenges of scale-up

SETTING: National Institute of Diseases of the Chest and Hospital, Dhaka; Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka; and Chittagong Chest Disease Hospital, Chittagong, Bangladesh.OBJECTIVE: To present operational data and discuss the ch...

Full description

Saved in:
Bibliographic Details
Published in:The international journal of tuberculosis and lung disease 2017-09, Vol.21 (9), p.1020-1025
Main Authors: Nathavitharana, R. R., Daru, P., Barrera, A. E., Mostofa Kamal, S. M., Islam, S., ul-Alam, M., Sultana, R., Rahman, M., Hossain, Md. S., Lederer, P., Hurwitz, S., Chakraborty, K., Kak, N., Tierney, D. B., Nardell, E.
Format: Article
Language:English
Subjects:
Chest
Diabetes mellitus
Diagnostic systems
Disease transmission
Fast
Implementation
Lung diseases
Metabolic disorders
Multidrug resistance
Multidrug resistant organisms
Nosocomial Transmission
Patients
Rehabilitation
Shortages
Sustainability
Tuberculosis
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:SETTING: National Institute of Diseases of the Chest and Hospital, Dhaka; Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka; and Chittagong Chest Disease Hospital, Chittagong, Bangladesh.OBJECTIVE: To present operational data and discuss the challenges of implementing FAST (Find cases Actively, Separate safely and Treat effectively) as a tuberculosis (TB) transmission control strategy.DESIGN: FAST was implemented sequentially at three hospitals.RESULTS: Using Xpert® MTB/RIF, 733/6028 (12.2%, 95%CI 11.4-13.0) patients were diagnosed with unsuspected TB. Patients with a history of TB who were admitted with other lung diseases had more than twice the odds of being diagnosed with unsuspected TB as those with no history of TB (OR 2.6, 95%CI 2.2-3.0, P < 0.001). Unsuspected multidrug-resistant TB (MDR-TB) was diagnosed in 89/1415 patients (6.3%, 95%CI 5.1-7.7). Patients with unsuspected TB had nearly five times the odds of being diagnosed with MDR-TB than those admitted with a known TB diagnosis (OR 4.9, 95%CI 3.1-7.6, P < 0.001). Implementation challenges include staff shortages, diagnostic failure, supply-chain issues and reliance on external funding.CONCLUSION: FAST implementation revealed a high frequency of unsuspected TB in hospitalized patients in Bangladesh. Patients with a previous history of TB have an increased risk of being diagnosed with unsuspected TB. Ensuring financial resources, stakeholder engagement and laboratory capacity are important for sustainability and scalability.
ISSN:1027-3719
1815-7920
DOI:10.5588/ijtld.16.0794