FAST Strategy - A Sustainable Administrative TB Infection Control Measure in Nigeria: Reducing Time to TB Diagnosis and Enrolment to Treatment
Science Journal of Public Health
Volume 4, Issue 4, July 2016, Pages: 352-358
Received: Mar. 1, 2016; Accepted: Mar. 18, 2016; Published: Jul. 28, 2016
Views 2870      Downloads 54
Authors
Useni Sani, KNCV Tuberculosis Foundation, Abuja, Nigeria
Gidado Mustapha, KNCV Tuberculosis Foundation, Abuja, Nigeria
Onazi Jumoke, KNCV Tuberculosis Foundation, Abuja, Nigeria
Eneogu Rupert, KNCV Tuberculosis Foundation, Abuja, Nigeria
Chukwueme Nkemdilim, KNCV Tuberculosis Foundation, Abuja, Nigeria
Ubochioma Emperor, National Tuberculosis and Leprosy Control Program, Federal Ministry of Health, Abuja, Nigeria
Akang Gabriel, National Tuberculosis and Leprosy Control Program, Federal Ministry of Health, Abuja, Nigeria
Obot Valerie, Akwa Ibom State Tuberculosis and Leprosy Control Program, Akwa Ibom State Ministry of Health, Uyo, Nigeria
Omoniyi Amos, World Health Organization, Abuja, Nigeria
Article Tools
Follow on us
Abstract
FAST stands for Finding, Actively, Separating, and Treating. FAST focus health care workers on the most important administrative Tuberculosis (TB) transmission control intervention: effective TB treatment reduces TB spread rapidly, even before sputum smear and culture turn negative. General outpatient department (GOPD) and inpatient clinics in most public and some private health institutions are overcrowded with long waiting times to access health care services. This has led to an increasing importance to ensure effective TB prevention and control especially in settings were Presumptive TB cases, confirmed TB cases and People living with HIV (PLHIV) are seen. This study is aimed at describing the process of FAST implementation and its effect on reduction of time to diagnosis of TB and enrolment for care at tertiary Health care facilities. A prospective study in 12 facilities of 6 states with high TB and HIV burden; adapted guidelines, standard operating procedures (SOPs) and training materials for FAST strategy; trained pool of facilitators; field tested tools; advocacy visits to health facilities; collected base line data that preceded facility level sensitization of FAST implementation. Diagnosis of TB and DR-TB was in line with the national guidelines with the use of Acid Fast Bacilli (AFB) light microscopy and GeneXpert MTB/RIF technology. Follow-up evaluations were conducted monthly by State Tuberculosis and Leprosy Control Program (STBLCP) and quarterly by National TBL Control Program (NTBLCP). Data was analyzed using Stata 13 version 1 for paired t-test (mean comparison test). Average time to diagnosis of susceptible TB using 3 sputa samples reduced from a baseline of 2.9 days in April 2014 to 1.9 days by end of September 2014. Time to treatment of susceptible TB cases diagnosed either by AFB microscopy or Xpert reduced from a baseline of 3.9 days to 1.1 days. Similarly, average time for DR-TB cases diagnosed (including patients receiving their results) reduced from 2.3 days to 1 day. Proportion of TB cases diagnosed and started on treatment increased by up to 14-56% range among different facilities. Integrating FAST into health care delivery improves early diagnosis and enrolment to care at minimal cost; facilitate TB infection control in clinic waiting areas especially in low income countries like Nigeria. FAST also has additional advantage of increasing TB case notification.
Keywords
TB Infection Control, Intensified Case Finding, Health System Delay
To cite this article
Useni Sani, Gidado Mustapha, Onazi Jumoke, Eneogu Rupert, Chukwueme Nkemdilim, Ubochioma Emperor, Akang Gabriel, Obot Valerie, Omoniyi Amos, FAST Strategy - A Sustainable Administrative TB Infection Control Measure in Nigeria: Reducing Time to TB Diagnosis and Enrolment to Treatment, Science Journal of Public Health. Vol. 4, No. 4, 2016, pp. 352-358. doi: 10.11648/j.sjph.20160404.23
Copyright
Copyright © 2016 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[1]
Federal Ministry of Health, Department of Public Health. National TB Prevalence survey 2012.
[2]
Association for Reproductive and Family Health, Nigeria: Global Fund to Fight AIDs, Tuberculosis and Malaria Phase 1 recipient. Knowledge, Attitude and Practice of TB in Nigeria 2012.
[3]
Federal Ministry of Health, Department of Public Health. National DR-TB Prevalence survey 2010.
[4]
Federal Ministry of Health, Department of Public Health. National tuberculosis and leprosy control programme Annual report 2013.
[5]
World Health Organization. Global TB report WHO/HTM/TB/2013.11.
[6]
WHO: WHO Policy on TB Infection Control in Health-Care Facilities, Congregate Settings and Households 2010.
[7]
STOP TB Partnership. Global Plan to Stop TB 2011 – 2015
[8]
Federal Ministry of Health, Department of Public Health. National guidelines for TB Infection Control 2008.
[9]
Ogbonnaya L. U, Chukwu J. N, Uwakwe K. A, Oyibo P. G, Ndukwe C. D. The status of tuberculosis infection control measures in health care facilities rendering joint TB/HIV services in "German Leprosy and Tuberculosis Relief Association" supported states in Nigeria. Niger J Clin Pract. 2011 Jul-Sep; 14 (3): 270-5. doi: 10.4103/1119-3077.86765.
[10]
Alonso-Echanove J, Granich RM, Laszlo A, Chu G, Borja N, et al.: Occupational transmission of Mycobacterium tuberculosis to health care workers in a university hospital in Lima, Peru Clin Infect Dis 2001, 33: 589-596.
[11]
Gandhi NR, Moll A, Sturm AW, Pawinski R, Govender T, et al.: Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa Lancet 2006, 368: 1575-1580.
[12]
Lawn SD, Afful B, Acheampong JW: Pulmonary tuberculosis: Diagnostic delay in Ghanaian adults. Int J Tuberc Lung Dis 1998, 2: 635-640.
[13]
Counsell SR, Tan JS, Dittus RS: Unsuspected pulmonary tuberculosis in a community teaching hospital. Arch Intern Med 1989, 149: 1274-1278.
[14]
Heldal E: Notification of tuberculosis in Norway [in Norwegian]. Norsk Epidemiologi 1995, 5: 15-17.
[15]
World Health Organization: Tuberculosis Handbook. Geneva, Switzerland: WHO; 1998.
[16]
Steen TW, Mazonde GN: Pulmonary tuberculosis in Kweneng District, Botswana: delay in diagnosis in 212 smear-positive patients. Int J Tuberc Lung Dis 1998, 2: 627-634.
[17]
Sherman LF, Fujiwara PI, Cook SV, Bazerman LB, Frieden TR: Patient and health care system delays in the diagnosis and treatment of tuberculosis. Int J Tuberc Lung Dis 1999, 3: 1088-1095.
[18]
Beyers N, Gie RP, Schaaf HS, van Zyl S, Nel ED, Talent JM, Donald PR: Delay in the diagnosis, notification and initiation of treatment and compliance in children with tuberculosis. Tuber Lung Dis 1994, 75: 260-265.
[19]
Güneylioglu D, Yilmaz A, Bilgin S, Bayram U, Akkaya E. Factors affecting delays in diagnosis and treatment of pulmonary tuberculosis in a tertiary care hospital in Istanbul, Turkey. Med Sci Monit. 2004 Feb; 10 (2): CR62-7.
[20]
Nardell E. and Dharmadhikari A. Turning off the spigot: reducing drug-resistant tuberculosis transmission in resource-limited settings. Int J Tuberc Lung Dis. Oct 2010; 14 (10): 1233–1243.
[21]
Reid M. J, Saito S, Nash D, Scardigli A, Casalini C, Howard A. A. implementation of tuberculosis infection control measures at HIV care and treatment sites in sub-Saharan Africa. Int J Tuberc Lung Dis. 2012 Dec; 16 (12): 1605-12. doi: 10.5588/ijtld.12.0033
[22]
Finnie RK, Khoza LB, van den Borne B, Mabunda T, Abotchie P, Mullen PD: Factors associated with patient and health care system delay in diagnosis and treatment for TB in sub-Saharan African countries with high burdens of TB and HIV. Trop Med Int Health 2011, 16 (4): 394-411.
[23]
Guang Xue He, Susan van den Hof, Marieke J van der Werf, Guo Jie Wang, Shi Wen Ma, Dong Yang Zhao, Yuan Lian Hu, Shi Cheng Yu and Martien W Borgdorff: Infection control and the burden of tuberculosis infection and disease in health care workers in china: a cross-sectional study. BMC Infectious Diseases 2010, 10: 313 doi: 10.1186/1471-2334-10-313.
[24]
A. Roderick Escombe, David A. Moore, Robert Gilman, William Pan: The Infectiousness of Tuberculosis Patients Co-infected with HIV. DOI: 10.1371/journal.pmed.0050188.
ADDRESS
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
U.S.A.
Tel: (001)347-983-5186