Find Actively, Separate, Treat: The FAST Strategy for Tuberculosis Infection Control in Bangladesh
Bangladesh is one of the world’s high tuberculosis (TB) burden countries. According to World Health Organization’s 2017 Global TB Report, 38% of drug-sensitive and approximately 84% of drug-resistant patients are undiagnosed or unreported. The most infectious TB patients are these missing cases. Undiagnosed TB patients often transmit the disease in inpatient wards, infecting health care workers, patient attendants, and other patients. It is critical to find, diagnose, and effectively treat these TB patients to thwart the transmission of the disease. TB patients may present themselves to the hospital for reasons having nothing to do with TB, and they may not mention cough, fever, or weight loss —symptoms that may or may not be associated with pulmonary TB. Large hospitals and nongovernmental organization (NGO) clinics in urban Dhaka are a hub for these patients by acting as entry points for both patients and caregivers from a large catchment area. In response to patient volume and health facility capacity, the USAID-funded Challenge TB (CTB) Project in Bangladesh introduced the FAST strategy (Find patients Actively, Separate safely, and Treat effectively) as a TB infection control strategy that prioritizes rapidly diagnosing patients and starting effective treatment. The premise of the FAST strategy is that TB treatment can prevent further transmission. Rapidly diagnosing and treating TB patients is the best way to reduce nosocomial infections, especially for health care workers who are at high risk of infection due to routine direct patient care. The FAST strategy is used to diagnose TB or multidrug-resistant TB (MDR-TB) within a variety of health care and congregant settings and is an infection control strategy with a focused approach for stopping TB transmission.