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. 2017 Sep 1;21(9):1020-1025.
doi: 10.5588/ijtld.16.0794.

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

R R Nathavitharana  1 , P Daru  2 , A E Barrera  3 , S M Mostofa Kamal  4 , S Islam  4 , M Ul-Alam  4 , R Sultana  4 , M Rahman  4 , Md S Hossain  4 , P Lederer  5 , S Hurwitz  6 , K Chakraborty  2 , N Kak  2 , D B Tierney  7 , E Nardell  7
Affiliations

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

R R Nathavitharana et al. Int J Tuberc Lung Dis. .

Abstract

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.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. FAST Algorithm at Hospital sites in Bangladesh
*All patients admitted to NIDCH and Chittagong Chest Hospital were eligible (since these are respiratory disease hospitals) and underwent Xpert testing as part of FAST. At BIRDEM, patients were screened for cough and underwent Xpert testing through FAST if cough was reported.
Figure 2
Figure 2
FAST implementation analyzed using the Consolidated Framework for Implementation Research (CFIR).
See this image and copyright information in PMC

References

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