Abstract
Objective:To evaluate the effect of the FAST (Find cases Actively, Separate safely, Treat effectively) strategy on time to tuberculosis diagnosis and treatment for patients at a general hospital in a tuberculosis-endemic setting.Design:Prospective cohort study with historical controls.Participants:Patients diagnosed with pulmonary tuberculosis during hospitalization at Hospital Nacional Hipolito Unanue in Lima, Peru.Methods:The FAST strategy was implemented from July 24, 2016, to December 31, 2019. We compared the proportion of patients with drug susceptibility testing and tuberculosis treatment during FAST to the 6-month period prior to FAST. Times to diagnosis and tuberculosis treatment were also compared using Kaplan-Meier plots and Cox regressions.Results:We analyzed 75 patients diagnosed with pulmonary tuberculosis through FAST. The historical cohort comprised 76 patients. More FAST patients underwent drug susceptibility testing (98.7% vs 57.8%; OR, 53.8; P < .001), which led to the diagnosis of drug-resistant tuberculosis in 18 (24.3%) of 74 of the prospective cohort and 4 (9%) of 44 of the historical cohort (OR, 3.2; P = .03). Overall, 55 FAST patients (73.3%) started tuberculosis treatment during hospitalization compared to 39 (51.3%) controls (OR, 2.44; P = .012). FAST reduced the time from hospital admission to the start of TB treatment (HR, 2.11; 95% CI, 1.39–3.21; P < .001).Conclusions:Using the FAST strategy improved the diagnosis of drug-resistant tuberculosis and the likelihood and speed of starting treatment among patients with pulmonary tuberculosis at a general hospital in a tuberculosis-endemic setting. In these settings, the FAST strategy should be considered to reduce tuberculosis transmission while simultaneously improving the quality of care.
Highlights
Awareness is growing about the need to improve TB screening, diagnosis, and treatment to achieve TB transmission control in the hospital.[17,18] Modeling reveals that decreasing exposure to patients with infectious TB through improved case detection and delivery of care will reduce transmission.[19]
Three patients were diagnosed in phase 1 of FAST implementation, 16 were diagnosed in phase 2, and 56 were diagnosed in phase 3
Our study uniquely assessed how FAST could be used to enhance indicated treatment, that is, a regimen tailored to drug-susceptibility testing (DST) results and following local guidelines
Summary
Awareness is growing about the need to improve TB screening, diagnosis, and treatment to achieve TB transmission control in the hospital.[17,18] Modeling reveals that decreasing exposure to patients with infectious TB through improved case detection and delivery of care will reduce transmission.[19] The FAST (Find cases Actively, Separate safely, Treat effectively) strategy has been developed to speed the delivery of key elements of TB care to reduce hospital transmission of TB from patients with undiagnosed and/or untreated disease.[20,2]
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