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

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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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Keywords: FAST; TB; implementation; nosocomial transmission

Document Type: Research Article

Affiliations: 1: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts 2: University Research Co., Washington DC 3: Faculty of Nursing Science, University of Pennsylvania, Philadelphia, Pennsylvania, USA 4: National Institute of Diseases of the Chest Hospital, Dhaka, Bangladesh 5: Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts 6: Division of Biostatistics, Brigham and Women's Hospital Center for Clinical Investigation, Boston, Massachusetts 7: Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA

Publication date: September 1, 2017

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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