H Le1, N Nguyen2, P Tran3, N Hoa4, N Hung2, A Moran5, H J Al Mossawi5, N Kak5, S Ahmedov6, M B Brooks7, E A Nardell8, D B Tierney8. 1. University Research Co, LLC, Hanoi. 2. National Lung Hospital/National TB Program, Hanoi. 3. Pham Ngoc Thach Hospital, Quang Nam, Viet Nam. 4. National Lung Hospital/National TB Program, Hanoi, Center for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France. 5. University Research Co, LLC, Chevy Chase, Maryland. 6. United States Agency for International Development, Washington, DC. 7. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts. 8. Division of Global Health Equity, Brigham & Women's Hospital, Boston, Massachusetts, USA.
Abstract
SETTING: The tuberculous infection control strategy, FAST (Find cases Actively, Separate safely and Treat effectively), recommends prompt initiation of likely effective anti-tuberculosis treatment informed by Xpert® MTB/RIF results. OBJECTIVE: To describe FAST implementation at Quang Nam Provincial TB and Lung Disease Hospital (QNH), Tam Ky, Viet Nam, using time to initiation of effective TB treatment as a process measure. DESIGN: Hospital logs were used to calculate the time to likely effective treatment in patients with pulmonary TB (PTB) hospitalised during the study period. RESULTS: Between 1 January and 31 December 2016, of 858 patients treated for PTB, 493 (57.5%) received likely effective treatment. The median time to likely effective treatment was 3 days (interquartile range 2.0-6.0), with 213 (43.2%) patients receiving likely effective treatment within 2 days. Of 81 patients receiving likely effective treatment for drug-susceptible TB with a positive Xpert result as their initial in-patient diagnostic test, 64 (79.0%) received likely effective treatment within 2 days compared with 10 (5.7%) who were initially smear-negative then found to be Xpert-positive (P < 0.0001). CONCLUSIONS: A 'time to' process measure of the FAST tuberculous infection control strategy indicates delays in the initiation of likely effective anti-tuberculosis treatment in a resource-limited hospital. Expanding access to Xpert may speed time to likely effective treatment.
SETTING: The tuberculous infection control strategy, FAST (Find cases Actively, Separate safely and Treat effectively), recommends prompt initiation of likely effective anti-tuberculosis treatment informed by Xpert® MTB/RIF results. OBJECTIVE: To describe FAST implementation at Quang Nam Provincial TB and Lung Disease Hospital (QNH), Tam Ky, Viet Nam, using time to initiation of effective TB treatment as a process measure. DESIGN: Hospital logs were used to calculate the time to likely effective treatment in patients with pulmonary TB (PTB) hospitalised during the study period. RESULTS: Between 1 January and 31 December 2016, of 858 patients treated for PTB, 493 (57.5%) received likely effective treatment. The median time to likely effective treatment was 3 days (interquartile range 2.0-6.0), with 213 (43.2%) patients receiving likely effective treatment within 2 days. Of 81 patients receiving likely effective treatment for drug-susceptible TB with a positive Xpert result as their initial in-patient diagnostic test, 64 (79.0%) received likely effective treatment within 2 days compared with 10 (5.7%) who were initially smear-negative then found to be Xpert-positive (P < 0.0001). CONCLUSIONS: A 'time to' process measure of the FAST tuberculous infection control strategy indicates delays in the initiation of likely effective anti-tuberculosis treatment in a resource-limited hospital. Expanding access to Xpert may speed time to likely effective treatment.
Authors: Carlos Acuña-Villaorduña; Irene Ayakaka; Luiz Guilherme Schmidt-Castellani; Francis Mumbowa; Patricia Marques-Rodrigues; Mary Gaeddert; Laura F White; Moises Palaci; Jerrold J Ellner; Reynaldo Dietze; Moses Joloba; Kevin P Fennelly; Edward C Jones-López Journal: Open Forum Infect Dis Date: 2019-04-11 Impact factor: 3.835