Novel approaches to TB infection control in private general hospitals in Georgia T Gabunia1, I Khonelidze, N Solomonia, T Merabishvili, M Makharadze, G Kuchukhidze, M Danelia2 1. University Research Co. LLC 2. National Center for Disease Control and Public Health, Georgia October 13, 2017 1University Research Co., LLC, Tbilisi, Georgia, 2National Center for Disease Control and Public Health, Tbilisi, Georgia, 3National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia

Georgia: Country Background Population: 3.7 million 3,311 cases notified in 2016 (50% decrease over the last decade) Estimated proportion of TB case with MDR/RR: Among new cases 9.8% Among retreatment cases 40.1% RR-TB treatment success rate 44% (range 2008-13: 56%-44%, 2013 cohort) XDR-TB treatment success 21% (range 2008-13: 39%-21%, 2013 cohort)

Risk of TB transmission in health care settings in Georgia Occupational exposure to TB is a major health risk for healthcare workers in Georgia that is not addressed adequately through national policies and programmatic interventions In Georgia, TB related hospitalization remains common with 30% of patients with Drug Sensitive TB hospitalized and a vast majority of M/XDR TB patients spending on average 120 days in inpatient facilities LTBI Prevalence among Health Care Workers in TB facilities in Georgia is 55% and is 31% in non-TB facilities1 Annual risk of TB infection among HCW is unknown (1) Whitaker et al. PLOS Medicine 2013

Novel approaches to TB infection control implemented by the National Center for Disease Control and Public Health in Georgia with the USAID and Global Fund TB Project support Environmental controls Personal protection Administrative controls

FAST Strategy Finding TB cases Actively Separating safely A focused tuberculosis transmission control strategy that prioritizes the administrative components of traditional TB infection control: rapid diagnosis and effective treatment. FAST stands for Finding TB cases Actively Separating safely Treating effectively.

FAST implementation in General Hospital Settings in Georgia Initial Assessment: High patient flow Commitment of hospital leadership Access to quality TB diagnostics GeneXpert Lab training Referal to treatment and care Reorganize Patient's admission Protocol FAST protocol Training Measure FAST Foster Public-Private Partnership MOU between private hospitals and NCDC Joint implementation

FAST cascade in two general hospitals (18 months) Active cough surveillance at an entry point in a general hospital Immediate access to GeneXpert testing 1,565 patients tested with GeneXpert 188 patients (12%) MTB positive 35 patients (2%) were found with Rifampicin Resistance FAST contribution to the National Case Finding Efforts at two hospitals in 2016: 3.5% Link the patient to TB treatment services within the National TB Program

Where does FAST fit into the overall quality framework? SAFE EFFECTIVE EFFICIENT TIMELY EQUITABLE PATIENT-CENTERED Institute of Medicine Report, 2001

Lessons learned This experience showed that general hospitals are at increased risk of TB transmission Active TB case finding should be in place targeted at patients with cough and chronic lung conditions Policy support and sustainable funding can be obtained through demonstrating results of successful pilot NCDCPH decided to roll out the FAST in high volume district hospitals for country wide coverage.

Conclusion The FAST , as an effective strategy for preventing nosocomial transmission of TB, should be considered as a basic safety standard and incorporated into the national quality framework for all public and private hospitals through licensing or certification. NCDC supports country wide roll out of FAST by making GeneXpert a point of care diagnostic test at a vast majority of general district hospitals.

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