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

Autor:	Tierney DB; Brigham and Women's Hospital, Boston, Massachusetts, United States.; Harvard Medical School, Boston, Massachusetts, United States., Orvis E; Analysis Group, Boston, Massachusetts, United States., Nathavitharana RR; Harvard Medical School, Boston, Massachusetts, United States.; Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States., Hurwitz S; Brigham and Women's Hospital, Boston, Massachusetts, United States.; Harvard Medical School, Boston, Massachusetts, United States., Tintaya K; Socios En Salud Sucursal Peru, Lima, Peru., Vargas D; Hospital Nacional Hipolito Unanue, Lima, Peru., Segura P; Hospital Nacional Hipolito Unanue, Lima, Peru., de la Gala S; Socios En Salud Sucursal Peru, Lima, Peru., Lecca L; Socios En Salud Sucursal Peru, Lima, Peru., Mitnick CD; Brigham and Women's Hospital, Boston, Massachusetts, United States.; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States., Nardell EA; Brigham and Women's Hospital, Boston, Massachusetts, United States.; Harvard Medical School, Boston, Massachusetts, United States.
Jazyk:	angličtina
Zdroj:	Infection control and hospital epidemiology [Infect Control Hosp Epidemiol] 2022 Oct; Vol. 43 (10), pp. 1459-1465. Date of Electronic Publication: 2021 Oct 06.
DOI:	10.1017/ice.2021.422
Abstrakt:	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.
Databáze:	MEDLINE
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