Improving “Fast” Indicators of TB Infection Control through Targeted Health Workers Training; Findings from Facility Based Studies in Abia State, Nigeria

Abstract

Aim: The aim of this study was to assess the effect of health workers training and implementation of the FAST strategy on the “FAST” indicators at Abia State University Teaching Hospital (ABSUTH); a tertiary referral facility. ”FAST” strategy; a focused approach to stopping TB spread in congregate settings developed by TB Care1 stands for Finding TB cases Actively, Separating safely, and Treating effectively. Study Design: This was a facility based interventional study using control group design methods with ABSUTH as the intervention facility while Federal Medical Centre Umuahia (FMCU) was the control. Methodology: Health workers (74 across cadres; doctors, nurses, laboratory scientist and medical record staff)  selected through stratified random sampling were trained to ensure daily cough surveillance and screening for TB among patients at the General outpatient, medical wards and HIV clinic of ABSUTH under supervision of a “FAST” focal person.Baseline “Fast Indicators” in the facility TB records of newly diagnosed TB patients 3 months before and 3 months after the training intervention were obtained. Results: At baseline the “FAST” strategy indicators recorded in the study facility include time to diagnosis > 1 week, time to treatment 3.5 days, presumptive TB cases 92, number of cases commenced on treatment were 22 while presumptive DRTB cases was 0.33. This study observed a significant positive difference in all the “FAST” indicators following the intervention. Time to diagnosis decreased by 52%, time to treatment decreased by 17% while the number of presumptive TB cases increased by over 100%. Number of TB cases diagnosed also increased by 100% as well as the cases commenced on treatment by 91%, while number of diagnosed DRTB cases increased by over 100%.These were all statistically significant ( P=.013,.03, .032,  and .049 except time to treatment P= 0.053). Conclusion: The training intervention on ‘FAST” strategy of TB infection Control significantly improved FAST Indicators in the intervention facility with attendant reduction in diagnostic delays and increased case notification.