Finding and Treating Unsuspected and Resistant TB to Reduce Hospital Transmission
Finding and Treating Unsuspected and Resistant TB to Reduce Hospital Transmission
The study is designed to evaluate the clinical impact of a novel strategy for tuberculosis
 (TB) infection control known as FAST (Find cases Actively based on cough surveillance,
 Separate temporarily, and Treat effectively). It is anticipated that this will decrease time
 to effective treatment initiation and also decrease transmission of TB to health care
 workers.
There is longstanding evidence that tuberculosis (TB) transmission is not from TB patients on
 effective treatment, but from unsuspected cases, and cases with unsuspected drug resistance.
 This study seeks to investigate the implementation of a refocused TB transmission control
 approach that we call FAST (Find cases Actively based on cough surveillance, Separate
 temporarily, and Treat effectively based on molecular drug-susceptibility testing [DST]). We
 will conduct this study at Hospital Nacional Hipólito Unanue in Lima, Peru. Our hypothesis is
 that FAST will reduce delays in identifying infectious TB patients (and unsuspected drug
 resistance) entering the hospital, facilitate timely effective therapy, and thereby reduce
 the risk of TB transmission in a cost-effective manner. We will assess the impact of FAST on
 TB transmission by evaluating IGRA conversions among health care workers at the intervention
 site, Hospital Nacional Hipolito Unanue (HNHU), and two control sites, Hosptial Nacional
 Arzobispo Loayza (HNAL) and Hospital Nacional Sergio Bernales (HNSB). We will also evaluate
 acceptability and barriers to/facilitators of FAST, novel screening strategies, and health
 care worker IGRA testing using a mixed methods approach.
Inclusion Criteria (for patients):

 -  adult (≥ 18 years) patients who are receiving care in the emergency department or
 being admitted for inpatient care from any other hospital area

 -  patient presenting with cough or TB risk factors of prior or current TB diagnosis
 and/or contact of an individual with TB

 -  able to participate by providing a sputum sample and/or exhaled breath test sample

 Exclusion Criteria (for patients):

 -  no specific exclusion criteria at initial screening if the patient meets the above
 inclusion criteria.

 Inclusion Criteria (for health care workers):

 -  being an employee or intern at Hospital Nacional Hipolito Unanue (HNHU), Hospital
 Nacional Arzobispo Loayza (HNAL) or Hospital Nacional Sergio Bernales (HNSB) and
 deemed to be at risk of exposure to tuberculosis based on line of work

 -  age ≥ 18 years

 -  willing and able to provide informed consent for participation

 Exclusion Criteria (for health care workers):

 -  no specific exclusion criteria