P2B175: A Short Training Course in Focused Assessment with Sonography in Hiv-associated TB (FASH) in a Regional Government Hospital in the Peruvian Amazon

Background: Educational training in point-of-care ultrasound (POCUS) for health care workers in resource-limited settings is a well-studied global health effort shown to expand diagnostic capacity and improve patient care. Radiology services at the Hospital Regional de Loreto (HRL), a government-funded tertiary care facility in the city center of the Peruvian Amazon, are constrained by limited specialists and long wait times. HRL partners with the University of California Los Angeles (UCLA) Global Health Program to improve local capacity. In partnership, we piloted a training course in POCUS in January 2023. We trained physicians of different backgrounds on the “Focused Assessment with Sonography for HIV-associated TB” (FASH) exam to increase accessibility of ultrasound and augment TB diagnosis at HRL.

Methods: In this IRB-exempt study, a survey was administered to pediatric and infectious disease residents and attendings before a two-week training course on FASH. The survey was adapted from a FASH course led by UCLA faculty in partnership with hospitals in Malawi. The survey asked about participant experiences with caring for TB patients, POCUS, and the FASH exam. It also included six content-based questions to assess knowledge before and after course completion. Anonymized pre- and post-survey data were transferred to Microsoft Excel version 16.72 and analyzed using paired t-testing. A p-value of < 0.05 was deemed statistically significant.

Results: Twenty-two participants completed the pre-course survey and 11 completed the post-course survey. Participants included 15 residents (68%) and 7 attendings (32%). Participant specialty was divided evenly between the pediatric (45%) and infectious disease (55%) departments. On average, participants had 7 years of clinical experience. Eighty-two percent of participants had some experience using ultrasound to diagnose TB prior to the training course, although only 5% had experience with the FASH protocol (Table 1). Participants’ knowledge in the FASH technique improved after the two-week training course. There was a 41% increase in total knowledge questions answered correctly (p = 0.025), with 44% correct on the pre-course questions and 62% correct on the post-course questions. Ninety-one percent of participants reported that they would “likely” and “highly likely” incorporate FASH into their clinical practice. Ninety-one percent of participants agreed that the FASH exam would improve their ability to diagnose TB and that it would improve patient care in their hospital (Table 2).

Conclusion: A short training course in the FASH exam for non-radiologist physicians is feasible and led to increased knowledge in POCUS to support TB diagnosis in our cohort. Although limited due to small sample size and retention rate, our study is the first effort of a long-term collaboration between HRL and UCLA to expand ultrasound accessibility in a setting where radiological services are limited.