Scientific Publication

Challenges in detection and treatment of multidrug resistant tuberculosis patients in Vietnam

author(s) Hoang, T.T.T.. - Nguyen, N.V.. - Dinh, S.N. - Nguyen, H.B.
from UK Foreign, Commonwealth & Development Office (FCDO)
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themes
regions
  • South-Eastern Asia
  • Asia
  • World
  • Northern Europe
  • Europe
citation

Thuy Thi Thanh Hoang , Nhung Viet Nguyen, Sy Ngoc Dinh, Hoa Binh Nguyen, Frank Cobelens, Guy Thwaites, Huong Thien Nguyen, Anh Thu Nguyen, Pamela Wright and Heiman F. L. Wertheim (2015) Challenges in detection and treatment of multidrug resistant tuberculosis patients in Vietnam. BMC Public Health 2015 15:980. https://doi.org/10.1186/s12889-015-2338-5

Publications and datasets provided via GARDIAN

Abstract

Background Vietnam is ranked 14th among 27 countries with high burden of multidrug-resistant tuberculosis (MDR-TB). In 2009, the Vietnamese government issued a policy on MDR-TB called Programmatic Management of Drug-resistant Tuberculosis (PMDT) to enhance and scale up diagnosis and treatment services for MDR-TB. Here we assess the PMDT performance in 2013 to determine the challenges to the successful identification and enrollment for treatment of MDR-TB in Vietnam. Methods In 35 provinces implementing PMDT, we quantified the number of MDR-TB presumptive patients tested for MDR-TB by Xpert MTB/RIF and the number of MDR-TB patients started on second-line treatment. In addition, existing reports and documents related to MDR-TB policies and guidelines in Vietnam were reviewed, supplemented with focus group discussions and in-depth interviews with MDR-TB key staff members. Results 5,668 (31.2 %) of estimated 18,165 MDR-TB presumptive cases were tested by Xpert MTB/RIF and second-line treatment was provided to 948 out of 5100 (18.7 %) of MDR-TB patients. Those tested for MDR-TB were 340/3224 (10.5 %) of TB-HIV co-infected patients and 290/2214 (13.1 %) of patients who remained sputum smear-positive after 2 and 3 months of category I TB regimen. Qualitative findings revealed the following challenges to detection and enrollment of MDR-TB in Vietnam: insufficient TB screening capacity at district hospitals where TB units were not available and poor communication and implementation of policy changes. Instructions for policy changes were not always received, and training was inconsistent between training courses. The private sector did not adequately report MDR-TB cases to the NTP. Conclusions The proportion of MDR-TB patients diagnosed and enrolled for second-line treatment is less than 20 % of the estimated total. The low enrollment is largely due to the fact that many patients at risk are missed for MDR-TB screening. In order to detect more MDR-TB cases, Vietnam should intensify case finding of MDR-TB by a comprehensive strategy to screen for MDR-TB among new cases rather than targeting previously treated cases, in particular those with HIV co-infection and contacts of MDR-TB patients, and should engage the private sector in PMDT. This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)

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