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FAST implementation in Bangladesh: high frequency of unsuspected tuberculosis justifies challenges of scale-up.

ABSTRACT: National Institute of Diseases of the Chest and Hospital, Dhaka; Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka; and Chittagong Chest Disease Hospital, Chittagong, Bangladesh.To present operational data and discuss the challenges of implementing FAST (Find cases Actively, Separate safely and Treat effectively) as a tuberculosis (TB) transmission control strategy.FAST was implemented sequentially at three hospitals.Using Xpert® MTB/RIF, 733/6028 (12.2%, 95%CI 11.4-13.0) patients were diagnosed with unsuspected TB. Patients with a history of TB who were admitted with other lung diseases had more than twice the odds of being diagnosed with unsuspected TB as those with no history of TB (OR 2.6, 95%CI 2.2-3.0, P < 0.001). Unsuspected multidrug-resistant TB (MDR-TB) was diagnosed in 89/1415 patients (6.3%, 95%CI 5.1-7.7). Patients with unsuspected TB had nearly five times the odds of being diagnosed with MDR-TB than those admitted with a known TB diagnosis (OR 4.9, 95%CI 3.1-7.6, P < 0.001). Implementation challenges include staff shortages, diagnostic failure, supply-chain issues and reliance on external funding.FAST implementation revealed a high frequency of unsuspected TB in hospitalized patients in Bangladesh. Patients with a previous history of TB have an increased risk of being diagnosed with unsuspected TB. Ensuring financial resources, stakeholder engagement and laboratory capacity are important for sustainability and scalability.

SUBMITTER: Nathavitharana RR

PROVIDER: S-EPMC5757242 | biostudies-other | 2017 Sep

REPOSITORIES: biostudies-other

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<i>FAST</i> implementation in Bangladesh: high frequency of unsuspected tuberculosis justifies challenges of scale-up.

Nathavitharana R R RR Daru P P Barrera A E AE Mostofa Kamal S M SM Islam S S Ul-Alam M M Sultana R R Rahman M M Hossain Md S MS Lederer P P Hurwitz S S Chakraborty K K Kak N N Tierney D B DB Nardell E E

The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease 20170901 9

<h4>Setting</h4>National Institute of Diseases of the Chest and Hospital, Dhaka; Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka; and Chittagong Chest Disease Hospital, Chittagong, Bangladesh.<h4>Objective</h4>To present operational data and discuss the challenges of implementing FAST (Find cases Actively, Separate safely and Treat effectively) as a tuberculosis (TB) transmission control strategy.<h4>Design</h4>FAST was implemented sequen ...[more]

PMID: 28826452

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Project description:BackgroundThe World Health Organization (WHO) stresses the importance of active case-finding (ACF) for early detection of tuberculosis (TB), especially in the 30 high-burden countries that account for almost 90% of cases globally.ObjectiveTo describe the attitudes of National TB Programme (NTP) managers related to ACF policy development, implementation and scale-up in the 30 high-burden countries, and to review national TB strategic plans.MethodsThis was a mixed-methods study with an embedded design: A cross-sectional survey with NTP managers yielded quantitative and qualitative data. A review of national TB strategic plans complemented the results. All data were analyzed in parallel and merged in the interpretation of the findings.Results23 of the 30 NTP managers (77%) participated in the survey and 22 (73%) national TB strategic plans were reviewed. NTP managers considered managers in districts and regions key stakeholders for both ACF policy development and implementation. Different types of evidence were used to inform ACF policy, while there was a particular demand for local evidence. The NSPs reflected the NTP managers' unanimous agreement on the need for ACF scale-up, but not all included explicit aims and targets related to ACF. The NTP managers recognized that ACF may decrease health systems costs in the long-term, while acknowledging the risk for increased health system costs in the short-term. About 90% of the NTP managers declared that financial and human resources were currently lacking, while they also elaborated on strategies to overcome resource constraints.ConclusionNTP managers stated that ACF should be scaled up but reported resource constraints. Strategies to increase resources exist but may not yet have been fully implemented, e.g. generating local evidence including from operational research for advocacy. Managers in districts and regions were identified as key stakeholders whose involvement could help improve ACF policy development, implementation and scale-up.

Project description:Many effective innovations and interventions are never effectively scaled up. Implementation research (IR) has the promise of supporting scale-up through enabling rapid learning about the intervention and its fit with the context in which it is implemented. We integrate conceptual frameworks addressing different dimensions of scaling up (specifically, the attributes of the service or innovation being scaled, the actors involved, the context, and the scale-up strategy) and questions commonly addressed by IR (concerning acceptability, appropriateness, adoption, feasibility, fidelity to original design, implementation costs, coverage and sustainability) to explore how IR can support scale-up.We draw upon three IR studies conducted by Future Health Systems (FHS) in Afghanistan, Bangladesh and Uganda. We reviewed project documents from the period 2011-2016 to identify information related to the dimensions of scaling up. Further, for each country, we developed rich descriptions of how the research teams approached scaling up, and how IR contributed to scale-up. The rich descriptions were checked by FHS research teams. We identified common patterns and differences across the three cases.The three cases planned quite different innovations/interventions and had very different types of scale-up strategies. In all three cases, the research teams had extensive prior experience within the study communities, and little explicit attention was paid to contextual factors. All three cases involved complex interactions between the research teams and other stakeholders, among stakeholders, and between stakeholders and the intervention. The IR planned by the research teams focussed primarily on feasibility and effectiveness, but in practice, the research teams also had critical insights into other factors such as sustainability, acceptability, cost-effectiveness and appropriateness. Stakeholder analyses and other project management tools further complemented IR.IR can provide significant insights into how best to scale-up a particular intervention. To take advantage of insights from IR, scale-up strategies require flexibility and IR must also be sufficiently flexible to respond to new emerging questions. While commonly used conceptual frameworks for scale-up clearly delineate actors, such as implementers, target communities and the support team, in our experience, IR blurred the links between these groups.

Project description:Small-scale fisheries (SSFs) have been playing a crucial role in meeting the basic needs of millions of people around the world. Despite this, the sustainability of global fisheries is a growing concern, and the factors enabling or constraining the sustainable management of small-scale fisheries remain poorly understood. Hilsa shad (Tenualosa ilisha) is the single most valuable species harvested in Bangladesh waters, serves nutrition, income, and employment to the large population. This study analyzed the state and challenges of hilsa fishery in the Gangetic River systems (Padma and Meghna Rivers) by using two frameworks, namely the social-ecological systems (SES) and drivers-pressure-state-impact-responses (DPSIR) frameworks. Primary data for this analysis were collected by in-depth interviews (n = 130) and focus group discussions (n = 8) with various stakeholders in the hilsa fisheries. The perspectives explored here have been both critical and constructive, including the identification of problems and suggestions for improving the management of this particular social-ecological system. Hilsa fisheries, however, have come under severe threat since 2003 because of population growth, overfishing, pollution, climate change, the disruption of migration routes due to siltation, etc. All these have caused reduced catches and less stable incomes for fishers. This, in turn, has led to poverty, malnutrition, social tensions, stakeholder conflicts, and debt cycles amongst more impoverished fishing communities. These problems have been compounded by improved fishing technology amongst larger-scale ventures, the use of illegal fishing gears, and the non-compliance of government fishery management programs. Recommendations include the promotion of community-supported fisheries, the enhancement of stakeholder's social resilience, the introduction of co-management approach, an increase in incentives and formal financial supports, and possible community-managed sustainable ecotourism including hilsa fishing-based tourism.

Dataset Information

FAST implementation in Bangladesh: high frequency of unsuspected tuberculosis justifies challenges of scale-up.

Publications

<i>FAST</i> implementation in Bangladesh: high frequency of unsuspected tuberculosis justifies challenges of scale-up.

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