Turning Off the Tap: Using the FAST Approach to Stop the Spread of Drug-Resistant Tuberculosis in the Russian Federation

Miller, Ann C.; Livchits, Viktoria; Khan, Faiz Ahmad; Atwood, Sidney; Корниенко, С. В.; Kononenko, Yulia; Vasilyeva, Irina; Keshavjee, Salmaan

doi:10.1093/infdis/jiy190

Cited by 12 publications

(13 citation statements)

References 14 publications

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“…NTPs must pay attention to the WHO TB infection control guidelines which focus on early identification, isolation, and treatment of those with presumptive TB, infrastructure modifications (such as enlarged windows, open skylights, and open-air waiting rooms) to ensure appropriate natural ventilation and air flow, use of ultraviolet germicidal irradiation fixtures (if applicable and affordable), better organization to avoid patient congestion, and provision of personal protective measures for health workers ( Table 4 ) 36 . For drug-resistant TB, the introduction of the FAST strategy (find cases actively, separate safely, and treat effectively) has been associated with a significant reduction of hospital-based acquisition of MDR-TB in the Russian Federation 37 , and this approach should be encouraged in other countries. An important monitoring indicator for effective implementation within health facilities is the number and proportion of health-care workers who develop TB each year, and this should be routinely reported by NTPs.…”

Section: Implement and Monitor Effective Infection Control Practicesmentioning

confidence: 99%

What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030?

et al. 2018

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The international community has committed to ending the tuberculosis (TB) epidemic by 2030. This will require multi-sectoral action with a focus on accelerating socio-economic development, developing and implementing new tools, and expanding health insurance coverage. Within this broad framework, National TB Programmes (NTPs) are accountable for delivering diagnostic, treatment, and preventive services. There are large gaps in the delivery of these services, and the aim of this article is to review the crucial activities and interventions that NTPs must implement in order to meet global targets and milestones that will end the TB epidemic. The key deliverables are the following: turn End TB targets and milestones into national measurable indicators to make it easier to track progress; optimize the prompt and accurate diagnosis of all types of TB; provide rapid, complete, and effective treatment to all those diagnosed with TB; implement and monitor effective infection control practices; diagnose and treat drug-resistant TB, associated HIV infection, and diabetes mellitus; design and implement active case finding strategies for high-risk groups and link them to the treatment of latent TB infection; engage with the private-for-profit sector; and empower the Central Unit of the NTP particularly in relation to data-driven supportive supervision, operational research, and sustained financing. The glaring gaps in the delivery of TB services must be remedied, and some of these gaps will require new paradigms and ways of working which include patient-centered and higher-quality services. There must also be fast-track ways of incorporating new diagnostic, treatment, and prevention tools into program activities so as to rapidly reduce TB incidence and mortality and meet the goal of ending TB by 2030.

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Section: Implement and Monitor Effective Infection Control Practicesmentioning

confidence: 99%

What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030?

et al. 2018

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“…Other, administrative approaches can reduce the risk of airborne infection in buildings. Unsuspected, infectious TB cases can be quickly identified by active case finding and rendered quickly non‐infectious by prompt, effective treatment . Ambulatory, community‐based treatment for TB, even drug‐resistant TB, can reduce hospitalization.…”

Section: (Modified From Davis and Gertler) Shows The Potential For Aimentioning

confidence: 99%

Cool but dangerous: How climate change is increasing the risk of airborne infections

et al. 2020

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Cool but dangerous: How climate change is increasing the risk of airborne infectionsLess obvious but more certain and immediate than future droughts and floods, the escalating use of air conditioning (AC) globally is directly resulting in conditions favoring increased person-to-person transmission of airborne infections such as tuberculosis (TB), influenza (flu), and measles. Unlike the gradual environmental effects of increased CO 2 emissions, the impact of AC on airborne infection is nearly instantaneous. This is because for efficient AC use, windows and doors must be closed, immediately eliminating the natural ventilation upon which much of the world depend for diluting and disinfecting room air. Moreover, the most common, highly efficient AC models are ductless or split units, that is, they quietly cool and F I G U R E 2 An example of a Germicidal UV fixture above the window used together with low-velocity ceiling fan for mixing upper and lower room air Low-velocity ceiling fan Upper room GUV fixture

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“…As is the case for TB transmission prevention overall, the cornerstone of MDR-TB transmission prevention should focus on earlier diagnosis and prompt initiation of effective therapy for all patients with DR-TB, since transmission is driven by patients with unsuspected DR-TB (this includes patients on treatment for DS-TB who have undiagnosed DR-TB as well as those who remain both undiagnosed and untreated) 15 . This strategy will improve individual outcomes and decrease transmission by rendering these patients non-infectious.…”

Section: Introductionmentioning

confidence: 99%

“…During the months that it took to observe treatment failure on treatment for DS-TB, patients with unsuspected MDR-TB transmitted their infection, thereby re-infecting patients with DS-TB. More recently, Xpert testing was applied to all new TB admissions to two TB hospitals in Russia 15 . Those testing positive were treated for MDR-TB within just a few days.…”

Section: Introductionmentioning

confidence: 99%

“…However, most of these countries practice prolonged and repeated hospitalization for TB, particularly DR-TB. In addition to active case finding, using TB molecular diagnostic tools in health care facilities, as described previously, 15 and shifting to predominantly ambulatory or community-based anti-TB treatment, and using environmental interventions to decrease TB (including DR-TB transmission) could be particularly important in these countries, where the cold climate limits ventilation in congregate settings, thereby amplifying transmission.…”

Section: Introductionmentioning

confidence: 99%

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Treatment as prevention and other interventions to reduce transmission of multidrug-resistant tuberculosis

Nathavitharana

Lederer

Tierney

et al. 2019

int j tuberc lung dis

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Summary Drug resistant tuberculosis (DR-TB) represents a major programmatic challenge at the national and global level. Only ~30% of patients with multidrug-resistant (MDR) TB were diagnosed and ~25% were initiated on therapy for MDR-TB in 2016. Increasing evidence now points towards primary transmission of DR-TB rather than inadequate treatment as the major driver of the DR-TB epidemic. The cornerstone of DR-TB transmission prevention should be earlier diagnosis and prompt initiation of effective treatment for all patients with DR-TB. Despite the extensive scale up of Xpert MTB/RIF testing, major implementation barriers continue to limit its impact. Although there is longstanding evidence in support of the rapid impact of treatment on patient infectiousness, delays in the initiation of effective DR-TB treatment persist, resulting in ongoing transmission. However, it is also imperative to address the burden of latent DR-TB infection, since it is estimated that many DR-TB patients will become infectious prior to seeking care and encounter various diagnostic delays before treatment. Addressing latent DR-TB primarily consists of identifying, treating and following contacts of patients with MDR-TB, typically through household contact evaluation. Adjunctive measures such as improved ventilation and use of germicidal ultraviolet (GUV) technology can further decrease TB transmission in high-risk congregate settings. Although many gaps remain in our biological understanding of TB transmission, implementation barriers to early diagnosis and rapid initiation of effective DR-TB treatment can and must be overcome if we are to impact DR-TB incidence in the short and long-term.

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Turning Off the Tap: Using the FAST Approach to Stop the Spread of Drug-Resistant Tuberculosis in the Russian Federation

Abstract: Nosocomial transmission contributes to the spread of multidrug-resistant (MDR) tuberculosis to patients with drug-susceptible tuberculosis. Use of the FAST strategy in 2 Russian hospitals was associated with significantly less MDR tuberculosis after 12 months.

Cited by 12 publications

References 14 publications

What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030?

What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030?

Cool but dangerous: How climate change is increasing the risk of airborne infections

Treatment as prevention and other interventions to reduce transmission of multidrug-resistant tuberculosis

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