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FAST implementation in Bangladesh: high frequency of unsuspected tuberculosis justifies challenges of scale-up
The paper presents operational data and discusses the challenges of implementing FAST (Find cases Actively, Separate safely and Treat effectively) as a tuberculosis transmission control strategy. FAST was implemented in three hospitals in Bangladesh.
Using Xpert MTB/RIF, 733/6028 (12.8%) 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. Unsuspected MDR TB was diagnosed in 89/1415 (6.3 percent) patients. Patients with unsuspected TB had nearly five times the odds of being diagnosed MDR TB than those admitted with a known TB diagnosis. Implementation challenges include staff shortages, diagnostic failure, supply-chain and funding issues.
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. Way Forward: URC-managed TB CARE II and other bilateral programs are continuing to refine and expand the FAST implementation as part of the TB transmission control among healthcare workers, patients and caregivers.