Abstract
To improve tuberculosis (TB) care among individuals attending a private tertiary care hospital in Vietnam, an innovative private sector engagement model was implemented from June to December 2018. This included: (i) Active facility-based screening of all adults for TB symptoms (and chest x-ray (CXR) for those with symptoms) by trained and incentivized providers, with on-site diagnostic testing or transport of sputum samples, (ii) a mobile application to reduce dropout in the care cascade and (iii) enhanced follow-up care by community health workers. We conducted a cohort study using project and routine surveillance data for evaluation. Among 52,078 attendees, 368 (0.7%) had symptoms suggestive of TB and abnormalities on CXR. Among them, 299 (81%) were tested and 103 (34.4%) were diagnosed with TB. In addition, 195 individuals with normal CXR were indicated for TB testing by attending clinicians, of whom, seven were diagnosed with TB. Of the 110 TB patients diagnosed, 104 (95%) were initiated on treatment and 97 (93%) had a successful treatment outcome. Given the success of this model, the National TB Programme is considering to scale it up nationwide after undertaking a detailed cost-effectiveness analysis.
Highlights
Tuberculosis (TB) is the leading cause of mortality from a single infectious agent globally, accounting for 1.45 million deaths annually [1]
We aimed to evaluate the performance of this private sector engagement model by tracking the cascade of tuberculosis care among the individuals attending the HIGH in Vietnam from June to December 2018.The specific objectives were to determine, (i) the number with presumptive tuberculosis and among them, the number who were investigated for tuberculosis (ii) the number diagnosed with tuberculosis and initiated on treatment (iii) the treatment outcomes among those initiated on treatment and (iv) the delays involved at different steps of the care cascade
TB = Tuberculosis; interquartile range (IQR) = Interquartile Range; HIGH = Haiphong International General Hospital. This is the first report from Vietnam evaluating an innovative public–private mix (PPM) model using an information technology based tool for improving tuberculosis care in private health sector
Summary
Tuberculosis (TB) is the leading cause of mortality from a single infectious agent globally, accounting for 1.45 million deaths annually [1]. While there has been progress, the rate of decline of TB incidence has been modest at ~2% each year [3]. At this rate, we will not be able to realize the goal of ending TB by 2030. The Stop TB Partnership recommends that countries should strive to achieve 90-(90)-90 targets (diagnosing 90% of all people with TB including 90% among key populations and treating 90% of them successfully) [4]. The gap of 3 million includes people who are not diagnosed and treated, and those managed in the private health sector, but not notified to National Tuberculosis Programmes (NTP)
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