Effectiveness and challenges of FAST implementation for tuberculosis case detection in Indonesian private hospital: A mixed-method study

Objectives: Tuberculosis (TB) is a leading cause of infectious disease deaths globally, with Indonesia among the top three affected countries.This study evaluates the effectiveness, challenges, and enablers of implementing FAST (Find cases Actively, Separate safely, and Treat effectively) to control TB. Methods:This study utilized an implementation research approach, employing a sequential explanatory design in a class B private teaching hospital in Central Java, Indonesia.The study included a retrospective data analysis of TB reports from January to December 2022, followed by qualitative exploration through observations, in-depth interviews, and focus group discussions with 12 healthcare workers (HCWs).Thematic analysis using a System Framework (structure-processoutput) integrated with quantitative findings provided a comprehensive understanding.Results: FAST implementation effectively improved TB case detection, with a strong association observed between its application and TB case finding rates (=108.052,df=1, p < 0.001).Among 172,058 outpatient visits, 64,432 were screened via FAST, yielding 281 new TB cases (0.16%).The FAST procedure demonstrated higher TB positivity with a Prevalence Ratio 2.59 (95% CI: 2.15-3.13).Key enablers included leadership support, robust hospital policies, infrastructure and equipment readiness, adequate and skilled HCWs, and multisector collaboration.However, limited hospital information systems, lack of ongoing motivational sessions and training, multiple hospital entry points, and suboptimal community engagement hindered optimal implementation.Conclusions: FAST effectively detects TB cases and shows potential for TB control in Indonesian private hospitals.A comprehensive and sustainable approach is crucial to ensure FAST J o u r n a l P r e -p r o o f implementation and follow-up of screening results through accurate diagnosis and timely treatment.