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

Hoang TT, Nguyen NV, Dinh SN, Nguyen HB, Cobelens F, Thwaites G, Nguyen HT, Nguyen AT, Wright P, Wertheim HF - BMC Public Health (2015)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: National Tuberculosis Control Program of Vietnam- National Lung Hospital (VNTP-NLH), Hanoi, Vietnam. hoangthanht@gmail.com.

ABSTRACT

Background: Vietnam is ranked 14(th) 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.

No MeSH data available.


Related in: MedlinePlus

PMDT performance for case detection and enrollment of MDR-TB in Vietnam
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4587724&req=5

Fig2: PMDT performance for case detection and enrollment of MDR-TB in Vietnam

Mentions: Of 997 rifampicin-resistant cases detected, 948 (95.1 %) were enrolled for MDR-TB treatment, accounting for just 18.7 % (95 % CI: 14.1–28.3 %) of the estimated 5065 MDR-TB cases in the whole of Vietnam (Fig. 2). The region with the highest proportion of MDR-TB patient enrolled for second-line treatment was the South-East region with 495/1546 (32.0 %; 95 % CI: 24.3–47.8 %), followed by the Red River Delta with 234/859 (27.3 %; 95 % CI: 20.5–41.4 %). The lowest enrollments were in the Mekong Delta region: 81/1288 (6.3 %; 95 % CI: 4.8–9.5 %). No enrollments were reported in PMDT for North-East, North-West and Central Highlands (Table 1, Fig. 3). Also in the 35 PMDT provinces, the enrollment proportion of MDR-TB cases was low: 948/3982 (23.8 %; 95 % CI:18.0–35.9 %). The highest proportion was seen in the PMDT provinces in the Red River Delta with 234/627(37.3 %; 95 % CI: 28.2–56.5 %), and South-East region: 495/1408 (35.2 %; 95 % CI: 26.7–52.4 %)Fig. 2


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

Hoang TT, Nguyen NV, Dinh SN, Nguyen HB, Cobelens F, Thwaites G, Nguyen HT, Nguyen AT, Wright P, Wertheim HF - BMC Public Health (2015)

PMDT performance for case detection and enrollment of MDR-TB in Vietnam
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4587724&req=5

Fig2: PMDT performance for case detection and enrollment of MDR-TB in Vietnam
Mentions: Of 997 rifampicin-resistant cases detected, 948 (95.1 %) were enrolled for MDR-TB treatment, accounting for just 18.7 % (95 % CI: 14.1–28.3 %) of the estimated 5065 MDR-TB cases in the whole of Vietnam (Fig. 2). The region with the highest proportion of MDR-TB patient enrolled for second-line treatment was the South-East region with 495/1546 (32.0 %; 95 % CI: 24.3–47.8 %), followed by the Red River Delta with 234/859 (27.3 %; 95 % CI: 20.5–41.4 %). The lowest enrollments were in the Mekong Delta region: 81/1288 (6.3 %; 95 % CI: 4.8–9.5 %). No enrollments were reported in PMDT for North-East, North-West and Central Highlands (Table 1, Fig. 3). Also in the 35 PMDT provinces, the enrollment proportion of MDR-TB cases was low: 948/3982 (23.8 %; 95 % CI:18.0–35.9 %). The highest proportion was seen in the PMDT provinces in the Red River Delta with 234/627(37.3 %; 95 % CI: 28.2–56.5 %), and South-East region: 495/1408 (35.2 %; 95 % CI: 26.7–52.4 %)Fig. 2

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: National Tuberculosis Control Program of Vietnam- National Lung Hospital (VNTP-NLH), Hanoi, Vietnam. hoangthanht@gmail.com.

ABSTRACT

Background: Vietnam is ranked 14(th) 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.

No MeSH data available.


Related in: MedlinePlus