25 Jul Philippines: TB Platforms project implements strategy to reduce spread of TB
[vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_separator type=”normal” thickness=”2″ up=”20″ down=”20″][/vc_column][/vc_row][vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_gallery type=”nivo” interval=”3″ images=”2835,2836″ img_size=”full”][vc_column_text]University Research Co., LLC (URC), through its TB Platforms for Sustainable Detection, Care and Treatment project (TB Platforms) has implemented a novel strategy called FAST in 3 big regions of the Philippines: National Capital Region (NCR), Region III and Region IV-A.
FAST (Finding cases Actively, Separating safely, Treating effectively) is an infection control strategy that aims to reduce the spread of tuberculosis in congregate settings through early diagnosis of TB and multidrug resistant TB (MDR-TB). The FAST strategy promotes the idea that early diagnosing and effectively treating TB patients are the best ways to reduce the spread of the disease, especially among healthcare workers who are at higher risk of infection due to routine direct patient care.
The infection control strategy lies on 3 main principles: cough surveillance, separating patients who are coughing from those who are not to reduce transmission and the use of rapid diagnostic tests to enable timely detection and treatment for all TB cases.
The FAST approach recommends all health facilities to systematically screen all patients for TB risks and symptoms – cough, fever, weight loss – that may or may not be associated with pulmonary TB. Identified presumptive TB cases are separated from other patients in a well-ventilated area and referred immediately for TB diagnostic tests. If found positive, TB patients are enrolled in appropriate TB treatment. The strategy also requires that healthcare staff adopt infection control measures from the time of patient referral to treatment initiation.
The target population for the project are all patients aged 15 years and older, both male and female, coming to the 24 hospitals spread through 9 project sites in NCR, Region III and Region IV-A in the Philippines. By implementing FAST in these hospitals, facilities are able to identify and implement stronger infection control measures, improve TB screening practices in outpatient departments, reduce TB diagnosis turn-around time and enhance early TB case detection and enrolment.
The implementation of FAST starts with an assessment of the hospital/health facility’s capacity to apply the strategy. The project uses a standardized assessment form to gather general information on the facility that includes hospital infrastructure for infection control; service provision; staffing for TB services and other complementary services; leadership availability and buy-in; availability of TB and MDR-TB diagnostics; and treatment commodities and supplies.
Other factors assessed include current time interval between confirmation of TB diagnosis and treatment initiation, as well as recording and reporting tools. The assessment is conducted with participation of the hospital staff and the FAST strategy is adapted to each health facility based on the assessment findings.
To improve tracking of the patient flow from screening to treatment, all hospital units involved in FAST implementation are provided with a FAST stamp, and are required to use it to mark all forms and registers through the cascade of care, such as test request forms, referrals to DOTS or satellite treatment center within or outside the hospital and laboratory registers.
At each facility, participating staff have their roles and responsibilities defined and are oriented in their roles which include cough surveillance, symptomatic screening, diagnosis, patient follow-up and treatment, recording, reporting and monitoring, supportive supervision and evaluation. Each hospital has a designated FAST coordinator who ensures that regardless of reason for consultation at the health facility, all patients are screened for active TB, diagnosed, and initiated on treatment if TB is confirmed.
From March to June 2019, the strategy was implemented in level 1 and 2 hospitals* in NCR, Region III and Region IV-A. During this period, FAST assessed 132’156 patients, among which 11’036 (8%) were presumptive TB cases. A total of 387 (4%) TB patients (373 DS TB and 14 DR TB) have been diagnosed and initiated on treatment.
*Level 1 Hospitals are very small facilities that offer initial treatment and primary care for prevalent diseases in the area. Level 1 hospitals usually include general medicine, pediatrics, minor surgeries, and non-surgical gynecology, primary clinical laboratory and a pharmacy.
Level 2 Hospitals are small hospitals with the same facilities of level 1 hospitals with the addition of departmentalized clinical services: surgery, obstetrics and gynecology, anesthesia, first level radiology and secondary clinical laboratory.
Out of the 373 diagnosed patients, 209 (54%) were clinically diagnosed and 178 (46%) were bacteriologically confirmed. The proportion of bacteriologically confirmed cases was significantly higher than the average 30% in the past years.
Compared with data from the same period of 2018, FAST implementation helped to increase the number of TB cases registered by 9%.
The numbers demonstrate that minimal systemic changes in diagnosis and treatment practices can significantly improve TB detection. Through simple facility-based policy changes, TB patients are identified and put on effective treatment which in turn reduces transmission of TB to health workers and other patients.
To increase efforts to find the missing people with TB, TB Platforms will support intensified case finding in rural health units at maternal and child health services and diabetic clinics. It will be recommended that all diabetes mellitus patients listed in the TB presumptive master list be given x-ray vouchers for free x-ray services to screen for TB.[/vc_column_text][/vc_column][/vc_row]