FAST tuberculosis transmission control strategy speeds the start of tuberculosis treatment at a general hospital in Lima, Peru

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.

Accuracy of digital chest x-ray analysis with artificial intelligence software as a triage and screening tool in hospitalized patients being evaluated for tuberculosis in Lima, Peru

“…We previously reported that the FAST strategy using Xpert for molecular diagnosis increased the yield of TB diagnosis and decreased time to treatment initiation[ 11 ]. Yet, despite WHO guidance that molecular WHO-recommended rapid TB diagnostic tests (mWRD) such as Xpert should be the initial test for people being evaluated for TB, implementation in Peru and other high-incidence settings has lagged[ 1 ].…”

“…We conducted a cross-sectional diagnostic accuracy study that was embedded in a larger prospective study evaluating FAST implementation at Hospital Nacional Hipolito Unanue (HNHU), a 700-bed public, tertiary-care referral hospital in Lima, Peru ( https://clinicaltrials.gov/ct2/show/NCT02355223 ). Patients admitted to HNHU from January 18th 2018 to December 31st 2019 were consecutively screened by the FAST implementation team study staff using a standardized questionnaire upon facility admission, as previously described[ 11 ]. This diagnostic accuracy sub-study consisted of two cohorts: triage and screening.…”

Accuracy of digital chest x-ray analysis with artificial intelligence software as a triage and screening tool in hospitalized patients being evaluated for tuberculosis in Lima, Peru

“…Patients admitted to HNHU from January 18th 2018 to December 31st 2019 were consecutively screened by the FAST implementation team study staff using a standardized questionnaire upon facility admission, as previously described (11). This diagnostic accuracy sub-study consisted of two cohorts: triage and screening.…”

Treatment of Infection as a Core Strategy to Prevent Rifampicin-Resistant/Multidrug-Resistant Tuberculosis

“…Most RR/MDR-TB transmission occurs prior to a diagnosis of RR/MDR-TB being made [ 17 ]. Many traditional infection prevention measures, however, are enacted after a person has been diagnosed with RR/MDR-TB.…”