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Summary Background Active case finding is recommended as an important strategy to control tuberculosis, particularly in low-income and middle-income countries with a high prevalence of the disease. However, the costs and cost-effectiveness of active case finding are unclear due to the absence of evidence from randomised trials. We assessed the costs and cost-effectiveness of an active case finding strategy in Vietnam, where there is a high prevalence of tuberculosis. Methods We conducted an economic evaluation alongside the Active Case Finding in Tuberculosis (ACT2) trial—a pragmatic cluster-randomised controlled trial in 70 districts across eight provinces of Vietnam. Patients aged 15 years and older with smear-positive pulmonary tuberculosis were recruited to the trial if they lived with one or more other household members. Household contacts were verbally invited to the clinic by the index patient with tuberculosis. ACT2 compared a combination of active and passive case finding with usual care (passive case finding) of household contacts of patients with tuberculosis from a health system perspective. Clustering occurred at the district and household level. Districts were the unit of randomisation, and we used minimisation to ensure balance of intervention and control districts within each province. In the intervention group, participants were invited to attend screening at baseline, 6 months, 12 months, and 24 months. We determined health-care costs with a standardised national costing survey and reported results in 2017 $US. The primary outcome of our study was disability-adjusted life years (DALYs) averted over a 24-month period. ACT2 was registered prospectively with the Australian and New Zealand Clinical Trials Registry, number ACTRN126.100.00600044. Findings Between Aug 11, 2010, and Aug 11, 2015, 10 964 index patients and 25 707 household contacts completed the ACT2 study. There were 10 069 household contacts in the intervention group and 15 638 household contacts in the control group. The incremental cost-effectiveness ratio per DALY averted was $544 (330–1375). Interpretation Active case finding was shown to be highly cost-effective in a setting with a high prevalence of tuberculosis. Investment in the wide-scale implementation of this programme in Vietnam should be strongly supported. Funding Australian National Health and Medical Research Council.

Objective Management of multidrug-resistant tuberculosis (MDR-TB) is a significant challenge to the global healthcare system due to the complexity and long duration of the MDR-TB treatment. This study analyzed the safety of patients on longer injectable-based MDR-TB treatment regimens using active pharmacovigilance data. Method We conducted an observational, prospective study based on active pharmacovigilance within the national TB program. A total of 659 MDR-TB patients were enrolled and followed up at 9 TB- hospitals in 9 provinces of all 3 regions in Vietnam between 2014 and 2016. Patients received a treatment regimen (standardized or individualized) based on their drug susceptibility test result and their treatment history. Baseline and follow-up information was collected at the start and during treatment. Adverse events (AE) were defined and classified as serious adverse events (SAEs) or otherwise. Multivariate Cox regression following the Iterative Bayesian Model Averaging algorithm was performed to identify factors associated with AE occurrence. Results Out of 659 patients assessed, 71.3% experienced at least one AE, and 17.5% suffered at least one SAE. The most common AEs were gastrointestinal disorders (38.5%), arthralgia (34.7%), and psychiatric disorders (30.0%). The proportion of patients with nephrotoxicity and hearing loss or vestibular disorders were 7.4% and 15.2%, respectively. 13.1% of patients required modifications or interruption of one or more drugs. In 77.7% of patients, treatment was completed successfully, while 9.3% lost to follow-up, in 3.0% treatment failed, and 7.4% died. Some significant risk factors for nephrotoxicity included diabetes mellitus (HR = 8.46 [1.91–37.42]), renal dysfunction (HR = 8.46 [1.91–37.42]), alcoholism (HR = 13.28 [5.04–34.99]), and a higher average daily dose of injectable drugs (HR = 1.28 [1.14–1.43]). Conclusion While a majority of patients on the longer injectable-based regimens experienced non-serious AEs during MDR-TB treatment, one in six patients experienced at least an SAE. Active TB drug-safety monitoring is useful to understand the safety of MDR-TB treatment and explore the risk factors for toxicity. All-oral, shorter MDR-TB regimens might be able to reduce the inconvenience, discomfort, and toxicity of such regimens and increase adherence and likelihood of successful completion.

Background Tuberculosis (TB) continues to account for significant morbidity and mortality annually. Household contacts (HHCs) of persons with TB are a key population for targeting prevention and control interventions. We aimed to identify risk factors associated with developing TB among HHCs. Methods We conducted a nested case-control study among HHCs in 8 provinces in Vietnam enrolled in a randomized controlled trial of active case finding for TB. Cases were any HHCs diagnosed and registered with TB within the Vietnam National TB Program during 2 years of follow-up. Controls were selected by simple random sampling from the remaining HHCs. Risk factor data were collected at enrollment and during follow-up. A logistic regression model was developed to determine predictors of TB among HHCs. Results We selected 1254 HHCs for the analysis: 214 cases and 1040 controls. Underlying characteristics varied between both groups; cases were older, more likely to be male, with a higher proportion of reported previous TB and diabetes. Risk factors associated with a TB diagnosis included being male (adjusted odds ratio [aOR], 1.4; 95% confidence interval [CI], 1.03–2.0), residing in an urban setting (aOR, 1.8; 1.3–2.5), prior TB (aOR, 4.6; 2.5–8.7), history of diabetes (aOR, 3.1; 1.7–5.8), current smoking (aOR, 3.1; 2.2–4.4), and prolonged history of coughing in the index case at enrollment (OR , 1.6; 1.1–2.3). Conclusions Household contacts remain an important key population for TB prevention and control. TB programs should ensure effective contact investigations are implemented for household contacts, particularly those with additional risk factors for developing TB.

Introduction Progress towards ending tuberculosis (TB) in Viet Nam includes monitoring the costs borne by patients through periodic facility-based surveys. Objective To document the magnitude of costs incurred by TB-affected households and establish a baseline for the top End TB indicator in Viet Nam. Methods A national survey with retrospective data collection and projection among 735 participants in 20 stratified clusters was conducted in 2016. Each patient was interviewed on costs, time loss, coping measures and asset ownership. Total costs were expressed as a proportion of annual household income. Results In Viet Nam, 63% of households affected by TB or multidrug-resistant TB (MDR-TB) experienced costs that were >20% of their annual household income. The mean patient costs were respectively US$1054 and US$4302 per episode of TB and MDR-TB. The most significant drivers of mean costs were income loss reported and purchase of special foods, nutritional supplements, travel and accommodation. Conclusion The proportion of households experiencing catastrophic total costs due to TB in Viet Nam is high, which poses a barrier to TB diagnosis and treatment. Based on study results, programme and partners need to identify key areas for policy action and work towards a national policy guide on intervention to reduce TB patient costs.

Setting Multidrug-resistant tuberculosis (MDR-TB) has become a major worldwide health problem. Various studies have been conducted on the cost of MDR-TB treatment; however, this has remained largely unexplored in Viet Nam. Objective To estimate the total cost of MDR-TB treatment at several health care facilities in Viet Nam. Design A prospective, prevalence-based study was conducted at three selected centers from March to June 2016 in 204 patients, 102 of whom were treated for 9 months and 102 for 20 months. Direct medical costs were calculated using electronic hospital databases, while a questionnaire was used to interview participants for evaluating direct non-medical and indirect costs. Total costs were estimated from a societal perspective in 2017 USD. Results Patients were mostly males aged 25-44 years. The average length of hospitalization in the 9-month treatment group was 168 ± 127 days; in the 20-month group, it was 671 ± 119 days. The average treatment cost for MDR-TB was respectively US$1480.34 ± 211.61 and US$2695.58 ± 294.98 for the 9- and 20-month treatment groups. Direct medical costs generally accounted for the highest proportion of the total costs, while the cost of pharmaceuticals and materials comprised the highest direct cost. Conclusion There was a significant difference in total costs among the three hospitals in the 9- and 20-month treatment groups.

SETTING The study was conducted in a randomly selected sample of persons aged 15 years living in Ca Mau Province, southern Viet Nam. OBJECTIVE To estimate the prevalence of latent tuberculous infection (LTBI) in the general adult population of this province of Viet Nam. The secondary objective was to examine age and sex differences in prevalence. DESIGN A cross-sectional survey was conducted in a cluster-random sample of the population. Clusters were subcommunes. The presence of LTBI was assessed using the QuantiFERON®-TB Gold In-Tube test system. RESULTS QuantiFERON tests were performed among 1319 persons aged 15 years (77.7% of those selected). The overall prevalence of positive tests was 36.8% (95%CI 33.4-40.3). The prevalence of a positive test was lower in females than in males (31.0% vs. 44.7%, OR 0.57, 95%CI 0.45-0.72, P < 0.0001). The prevalence of positive tests increased with increasing age quintile (P < 0.0001). CONCLUSION More than one third of the general adult population in a province in southern Viet Nam have evidence of LTBI. Although LTBI prevalence is higher in males, the sex difference is not as great as that for TB notification rates.

Background Active case finding is a top priority for the global control of tuberculosis, but robust evidence for its effectiveness in high-prevalence settings is lacking. We sought to evaluate the effectiveness of household-contact investigation, as compared with standard, passive measures alone, in Vietnam. Methods We performed a cluster-randomized, controlled trial at clinics in 70 districts (local government areas with an average population of approximately 500,000 in urban areas and 100,000 in rural areas) in eight provinces of Vietnam. Health workers at each district clinic or hospital were assigned to perform either household-contact intervention plus standard passive case finding (intervention group) or passive case finding alone (control group). In the intervention districts, household contacts of patients with positive results for tuberculosis on sputum smear microscopy (smear-positive tuberculosis) were invited for clinical assessment and chest radiography at baseline and at 6, 12, and ...

In 2016, the Viet Nam National Tuberculosis Programme (NTP) conducted the first national TB patients cost survey to identify the main cost drivers to help guide cost mitigation policies and reduce financial barriers to the treatment of TB patients. The survey findings were widely disseminated and the NTP defined a roadmap. The major components of the roadmap included 1) advocating for patients to be covered by social health insurance; 2) creating a charity fund for TB patients; 3) strengthening the collaboration between the Ministry of Health and Ministry of Labour and Social Affairs; and 4) advocating for donor support. The first national TB patients cost survey has shown that a high proportion of TB patients incurred costs that were classed as 'catastrophic'. The survey findings led to policy changes and new practices in Viet Nam.En 2016, le Programme National de lutte contre la Tuberculose (PNT) du Viet Nam a mené la première enquête nationale sur les coûts des patients avec la tuberculose (TB) afin d'identifier les principaux inducteurs de coûts permettant d'orienter les politiques de réduction des coûts et de réduire les obstacles financiers des patients tuberculeux. Les résultats de l'enquête ont été largement diffusés et le PNT a défini une feuille de route. Les principales composantes de la feuille de route étaient les suivantes : 1) plaider pour que les patients soient couverts par une assurance maladie sociale ; 2) créer un fonds de charité pour les patients avec la TB; 3) renforcer la collaboration avec le ministère du Travail et des Affaires sociales ; et 4) plaider pour le soutien des donateurs. La première enquête nationale sur les coûts des patients tuberculeux a montré qu'une forte proportion des patients tuberculeux ont encouru des coûts catastrophiques. Les résultats de la recherche ont conduit à des changements de politiques et à de nouvelles pratiques au Viet Nam.En el 2016, el Programa Nacional de Tuberculosis (PNT) de Viet Nam realizó la primera encuesta nacional sobre los costos que conlleva la tuberculosis (TB) para los pacientes a fin de definir los factores que los determinan, con el propósito de orientar las políticas de mitigación de costos y reducir los obstáculos económicos de los pacientes con TB. Se dio amplia difusión a los resultados de la encuesta y el PNT definió una hoja de ruta. Los principales componentes de la hoja de ruta incluían las siguientes medidas: 1) preconizar la cobertura de los pacientes por parte del seguro social de enfermedad; 2) crear una institución de beneficencia destinada a recaudar fondos para los pacientes con TB; 3) fortalecer la colaboración entre el Ministerio del Trabajo y el Ministerio de Asuntos Sociales; y 4) fomentar el respaldo de los donantes. La primera encuesta nacional sobre los costos sufragados por los pacientes con TB puso en evidencia que estos hacen frente a gastos catastróficos relacionados con la enfermedad. Los resultados de la investigación dieron lugar a modificaciones normativas y nuevas prácticas en Viet Nam.

Objectives Vietnam is a high-prevalence country for tuberculosis (TB). Xpert MTB/RIF is a novel PCR-based diagnostic test that is substantially more sensitive for detecting M. tuberculosis than traditional smear-based techniques. However, locally-derived evidence of Xpert MTB/RIF in HIV-infected people is limited. This study evaluates the performance of the Xpert MTB/RIF in HIV-infected patients with smear-negative pulmonary TB (SNTB). Methods This was a cross-sectional study in 3 hospitals. The performance of Xpert MTB/RIF was compared with the reference standard of liquid culture and phenotypic drug-susceptibility testing for rifampicin (RIF) resistance. Results Out of 123 patients, the median age was 37.0 (IQR: 32.0–41.0) and 81.3% were male. The area under the receiver operating characteristic curve, sensitivity (Se) and specificity (Sp) of Xpert MTB/RIF for pulmonary TB diagnosis were 0.72 (95% confidence interval [CI]: 0.63–0.81), 66.7% (95%CI: 54.8–77.1) and 77.1% (95%CI: 62.7–88.0), respectively, while Se and Sp of Xpert MTB/RIF in detecting RIF resistance were 50.0 (11.8–88.2) and 86.4% (95%CI: 72.7–94.8). Conclusion The performance of Xpert MTB/RIF in HIV-infected patients with SNTB for the diagnosis of TB and RIF-resistance was low. Further studies are required to evaluate the results of Xpert MTB/RIF assay in HIV-infected patients with SNTB and the role of Xpert repetition on the same specimens.

Background Differences in the prevalence of latent tuberculous infection (LTBI) and tuberculosis (TB) disease among contacts of patients with multidrug-resistant TB (MDR-TB) and drug-susceptible TB are not well understood. Objective To compare the prevalence of tuberculin skin test (TST) positivity in household contacts of patients with MDR-TB and in contacts of patients never previously treated for TB ('new TB'). Design Consecutive patients with MDR-TB and their household contacts at nine urban district clinics in Viet Nam were screened for TB and LTBI, and followed up for 6 months. LTBI was defined as a TST result of at least 10 mm. Results A total of 167 patients with TB and their 337 household contacts were recruited. A total of 167/180 (25.8%) contacts of new TB patients and 60/147 (40.8%) contacts of MDR-TB patients were TST-positive (odds ratio [OR] 2.0, 95%CI 1.3-3.2). Contacts of MDR-TB patients were more likely to have baseline chest radiograph findings consistent with TB (OR 2.6, 95%CI 1.4-5.0). Conclusion Contacts of MDR-TB patients have a high risk of developing TB. Measures to reduce Mycobacterium tuberculosis transmission and accelerate the detection of disease among high-risk contacts should be prioritised to curb the MDR-TB epidemic.

The End Tuberculosis (TB) Strategy has the ambitious goal of ending the global TB epidemic by the year 2030, which is aligned to the Sustainable Development Goals. One of three high level indicators of the Strategy is the “catastrophic costs” indicator, which aims to determine the proportion of TB-affected households that incur TB-care related costs equivalent to 20% or more of their annual household income. The target is that zero percentage of TB-affected households will incur catastrophic costs related to TB care by the year 2020. In the Western Pacific Region of the World Health Organization, it is a priority to determine the financial burden of TB and then act to mitigate it. To date, eight countries in the Region have conducted nationally representative TB patient cost surveys to determine the costs of TB care. The results from four countries that have completed these surveys (i.e., Fiji, Mongolia, the Philippines, and Vietnam) indicate that between 35% and 70% of TB patients face catastrophic costs related to their TB care. With these results in mind, significant additional efforts are needed to ensure financial risk protection for TB patients, expand Universal Health Coverage, and improve access to social protection interventions. A multi-sectoral approach is necessary to achieve this ambitious goal by the year 2020.

Background Tuberculosis (TB) and HIV remain a major causes of morbidity and mortality globally. We conducted an analysis of TB/HIV surveillance data to describe the trends in HIV testing coverage and HIV positivity rate among TB patients in Viet Nam, 2011–2017. Main text This was a descriptive study based on review and analysis of surveillance data from the National Tuberculosis Control Programme from 2011 to 2017. During this period, 721 342 TB cases were diagnosed. Of these, 520 490 (72.2%) had a previously documented HIV status or were tested for HIV during TB care and treatment. The proportion of TB patients whose HIV status was reported increased, from 58.5% in 2011 to 82.9% in 2017 (P value for trend = 0.014). The proportion of TB patients infected with HIV decreased, from 8.0% in 2011 to 3.7% in 2017 (P value for trend = 0.018). Conclusions The proportion of TB patients with a reported HIV status was increased from 2011 to 2017, however HIV testing coverage remained below the National Tuberculosis Control Programme targets (≥ 90%). National Tuberculosis Control Programme needs to focus on ensuring every registered TB patients has a documented HIV status, ensuring full coverage of HIV testing as part of routine TB care. Electronic supplementary material The online version of this article (10.1186/s40249-019-0536-6) contains supplementary material, which is available to authorized users.

BackgroundDespite the criticality of adherence to tuberculosis treatment, there is paucity of rigorous experimental research exploring the efficacy of interventions to promote adherence and a greater lack of inquiry addressing the integral role of adherence behaviour. The aim of this formative study was to examine the way in which the Wisepill evriMED Medication Event Reminder Monitor (MERM) was used among outpatients with drug susceptible pulmonary tuberculosis.MethodsIn depth interviews were conducted with 20 outpatients receiving treatment from two public healthcare facilities in Thanh Hoa, a rural province in northern Viet Nam. Patients had been enrolled in a randomized controlled trial evaluating the effect of using the MERM device upon adherence for between 1-3 months. The control group used the device without an alert, while the intervention group used the device with a daily alert and scheduled dosing history review.FindingsAll 20 patients interviewed were supportive of using the MERM device. Those able to be at home at the time that their treatment was due (50%) used the device as intended. Patients who worked all reported separating the time when the box was opened from the time at which they ingested their medication. Patients expressed fidelity to the prescribed medication taking time and concerns regarding the portability of the device. Limitations of the study surround the inclusion of a small sample population that did not experience factors that further compromise adherence.ConclusionsData recorded by the box did not always accurately reflect usage patterns. The alert in the intervention arm was able to support adherence only in patients who did not work while completing their treatment. MERM implementation can be improved by better aligning prescriber instructions with patients' daily routines, and increasing the use of adherence data to guide adherence support practices. Healthcare staff need to be aware of potential barriers to optimal use of MERM devices. A rigorous qualitative approach to formative assessment is essential to inform the scale up of new digital technologies.

In April 2009, an operational research fellow was placed within the Viet Nam National Tuberculosis Control Programme (NTP). Over the 6 years from 2010 to 2015, the OR fellow co-authored 21 tuberculosis research papers (as principal author in 15 [71%]). This constituted 23% of the 91 tuberculosis papers published in Viet Nam during this period. Of the 21 published papers, 16 (76%) contributed to changes in policy (En avril 2009, un responsable de recherche opérationnelle (RO) a été placé au sein du Programme national de Lutte contre la Tuberculose (PNT) du Viet Nam. Au cours de 6 ans, de 2010 à 2015, ce responsable a été le co-auteur de 21 articles de recherche relative à la tuberculose (et comme auteur principal pour 15 articles [71%]), et ceci a constitué 23% des 91 articles publiés sur la tuberculose au Viet Nam pendant cette période. Sur les 21 articles publiés, 16 (76%) ont contribué à changer la politique (En abril del 2009 se asignó un becario en investigación operativa al Programa Nacional de Control de la Tuberculosis (PNT) de Viet Nam. Durante un período de 6 años, del 2010 al 2015, el becario fue coautor de 21 artículos de investigación sobre tuberculose (primer autor en 15 de ellos [71%]), que representaron el 23% de los 91 artículos publicados sobre el tema en Viet Nam durante este período. De los 21 artículos publicados, 16 (76%) contribuyeron a una modificación de las políticas (

SETTING Community-wide active case finding for tuberculosis (TB) using Xpert® MTB/RIF as the primary screening tool, Ca Mau Province, Viet Nam. OBJECTIVES To determine whether macroscopic sputum quality characteristics (sputum colour and volume) can be used to predict Xpert MTB-negative sputum and hence exclude sputum samples from testing. DESIGN Field staff conducted household visits to approximately 51,200 adults in 58 villages randomly selected from throughout the province. Sputum samples from all screened participants who were able to produce ⩾1 ml sputum underwent macroscopic sputum assessment and were tested with Xpert. RESULTS Of the 21,624 sputum samples tested, 159 (0.74%) were Xpert MTB-positive; 93% of the samples were 1-2 ml and nearly all were mucoid (93%) or mucopurulent (5.7%). One salivary sample was Xpert MTB-positive (2.0% of all salivary samples). The lowest positive predictive value for any sputum volume or colour characteristic was 0.66%. This was not substantially different from the overall prevalence of positive sputum Xpert MTB (0.74%). CONCLUSION Sputum colour and volume cannot be used to predict the presence or absence of M. tuberculosis in sputum detected using Xpert. These sputum quality parameters cannot therefore be used to exclude sputum samples from testing for TB.

Background Diabetes mellitus (DM) is recognized as an important comorbidity for the development of tuberculosis (TB). With the increase of DM burden globally, concerns have been raised about the emerging co-epidemics of DM and TB, especially in low- and middle-income countries. Methods A facility-based, cross-sectional study was carried out in all 30 district TB units in Hanoi, Vietnam. All eligible, diagnosed TB patients aged 15 years old or older were asked to provide consent and were screened for diabetes using fasting blood glucose (FBG). Pre-tested semi-structured questionnaires were used for collecting demographic data, lifestyle habits and clinical data. Identification of pre-diabetes or diabetes in TB patients was done in accordance to parameters set by the American Diabetes Association (2016). Results Of 870 eligible TB patients, 831 (95.5%) participated in the study. Of those, 241 (29%; 95%CI: 25.9–32.1%) were prediabetic and 114 (13.7%; 95%CI: 11.4–16.1%) were found to have DM. The risk of DM was higher in patients belonging to the age group 40–64 years (OR 6.09; 95%CI 2.81–13.2); or the age group 65 years or older (OR 2.65; 95%CI 1.65–4.25) or who have a family history of DM (OR 2.71; 95%CI 1.33–5.50). Conclusions This study demonstrated high prevalence of DM and prediabetes among TB patients in Hanoi, Vietnam. National Tuberculosis Programme needs to establish a systematic screening process for DM among TB patients.

Background: Active case finding (ACF) is recommended as an important strategy to control tuberculosis (TB), particularly in high prevalence low- and middle- income (LMIC) settings. However, the costs and cost-effectiveness ACF have been uncertain, in the absence of evidence from randomised controlled trials (RCT). We investigated the cost-effectiveness of ACF in Vietnam based on the findings of a recent large-scale trial. Methods: We conducted a pragmatic cluster RCT conducted in 70 districts in eight provinces of Vietnam, comparing ACF plus standard passive case finding (PCF) to PCF alone among the household contacts of patients with TB. In the intervention group, participants were invited to attend screening at baseline, 6, 12 and 24 months. Healthcare costs were determined using a standardised national costing survey. The primary outcome was DALYs averted over a 24-month period. Secondary outcomes were the cumulative incidence of registered and smear-positive cases of tuberculosis among contacts. Findings: 10,069 and 15,638 household contacts were recruited to the intervention and control groups, respectively. The cost of ACF over a 24month period was $181 (95% CI 178 - 185) (2017 $USD) per person, compared to $83 (95% CI 83 - 83) per person for the control group. The incremental cost-effectiveness ratio was $544 (95% CI 330 - 1,375) per DALY averted. Interpretation: ACF was shown to be highly cost-effective in a high prevalence setting. Investment in the wide-scale implementation of this programme in Vietnam, and comparable settings, should be strongly supported. Funding: Australian National Health and Medical Research Council Declaration of Interests: There are no conflicts of interest to disclose Ethics approval was provided by the Human Research Ethics Committee at the University of Sydney and the Scientific Committee of the Vietnam Ministry of Health. The trial was registered prospectively with the Australian and New Zealand Clinical Trials Registry (ACTRN 12610000600044).

SETTING Viet Nam's Fourth National Anti-Tuberculosis Drug Resistance Survey was conducted in 2011. OBJECTIVE To determine the prevalence of resistance to the four main first-line anti-tuberculosis drugs in Viet Nam. METHODS Eighty clusters were selected using a probability proportion to size approach. Drug susceptibility testing (DST) against the four main first-line anti-tuberculosis drugs was performed. RESULTS A total of 1629 smear-positive tuberculosis (TB) patients were eligible for culture. Of these, DST results were available for 1312 patients, including 1105 new TB cases, 195 previously treated TB cases and 12 cases with an unknown treatment history. The proportion of cases with resistance to any drug was 32.7% (95%CI 29.1-36.5) among new cases and 54.2% (95%CI 44.3-63.7) among previously treated cases. The proportion of multidrug-resistant TB (MDR-TB) cases was 4.0% (95%CI 2.5-5.4) in new cases and 23.3 (95%CI 16.7-29.9) in previously treated cases. CONCLUSIONS The fourth drug resistance survey in Viet Nam found that the proportion of MDR-TB among new and previously treated cases was not significantly different from that in the 2005 survey. The National TB Programme should prioritise the detection and treatment of MDR-TB to reduce transmission of MDR-TB in the community.

Background Since 2005, the Myanmar National Tuberculosis Programme (NTP) has been implementing active case finding (ACF) activities involving mobile teams in hard-to-reach areas. This study revealed the contribution of mobile team activities to total tuberculosis (TB) case detection, characteristics of TB patients detected by mobile teams and their treatment outcomes. Methods This was a descriptive study using routine programme data between October 2014 and December 2014. Mobile team activities were a one-stop service and included portable digital chest radiography (CXR) and microscopy of two sputum samples. The algorithm of the case detection included screening patients by symptoms, then by CXR followed by sputum microscopy for confirmation. Diagnosed patients were started on treatment and followed until a final outcome was ascertained. Results A total of 9 349 people with symptoms suggestive of TB were screened by CXR, with an uptake of 96.6%. Of those who were meant to undergo sputum smear microscopy, 51.4% had sputum examinations. Finally, 504 TB patients were identified by the mobile teams and the overall contribution to total TB case detection in the respective townships was 25.3%. Among total cases examined by microscopy, 6.4% were sputum smear positive TB. Treatment success rate was high as 91.8% in study townships compared to national rate 85% (2014 cohort). Conclusions This study confirmed the feasibility and acceptability of ACF by mobile teams in hard-to-reach contexts, especially when equipped with portable, digital CXR machines that provided immediate results. However, the follow-up process of sputum examination created a significant barrier to confirmation of the diagnosis. In order to optimize the ACF through mobile team activity, future ACF activities were needed to be strengthened one stop service including molecular diagnostics or provision of sputum cups to all presumptive TB cases prior to CXR and testing if CXR suggestive of TB. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0291-5) contains supplementary material, which is available to authorized users.

Background It is estimated that the standard, passive case finding (PCF) strategy for detecting cases of tuberculosis (TB) in Myanmar has not been successful: 26% of cases are missing. Therefore, alternative strategies, such as active case finding (ACF) by community volunteers, have been initiated since 2011. This study aimed to assess the contribution of a Community Based TB Care Programme (CBTC) by local non-government organizations (NGOs) to TB case finding in Myanmar over 4 years. Methods This was a descriptive study using routine, monitoring data. Original data from the NGOs were sent to a central registry within the National TB Programme and data for this study were extracted from that database. Data from all 84 project townships in five regions and three states in Myanmar were used. The project was launched in 2011. Results Over time, the number of presumptive TB cases that were referred decreased, except in the Yangon Region, although in some areas, the numbers fluctuated. At the same time, there was a trend for the proportion of cases treated, compared to those referred, that decreased over time (P = 0.051). Overall, among 84 townships, the contribution of CBTC to total case detection deceased from 6% to 4% over time (P

SETTING: National Tuberculosis Programme, Viet Nam, 2008. OBJECTIVE: To assess the relationship between changes in body weight and tuberculosis (TB) treatment outcome. METHODS: All treatment cards of patients from a sample of 30 randomly selected treatment units in the country were analysed. RESULTS: Of 2609 patients, 2506 (96.1%) had a successful treatment outcome. The median body weight of all patients at diagnosis was 46.0 kg (25th and 75th percentiles 41-51). New sputum smear-positive TB patients with a successful treatment outcome gained an average of 2.6 kg during treatment. Patients with weight loss during the first 2 months of treatment were more likely to have an unsuccessful outcome than patients without (OR 4.9, 95%CI 3.0-7.9). Patients weighing

Setting: The programmatic management of drug-resistant tuberculosis (TB) in Viet Nam has been rapidly scaled up since 2009. Objectives: To document the annual numbers of patients enrolled for multidrug-resistant tuberculosis (MDR-TB) treatment during 2010–2014 and to determine characteristics and treatment outcomes of patients initiating treatment during 2010–2012. Design: A retrospective cohort study using national reports and data from the national electronic data system for drug-resistant TB. Results: The number of patients enrolled annually for MDR-TB treatment increased from 97 in 2010 to 1522 in 2014. The majority of patients were middle-aged men who had pulmonary disease and had failed a retreatment regimen; 77% had received ⩾2 courses of TB treatment. Favourable outcomes (cured and treatment completed) were attained in 73% of patients. Unfavourable outcomes included loss to follow-up (12.5%), death (8%) and failure (6.3%). Having had ⩾2 previous treatment courses and being human immunodeficiency virus-positive were associated with unfavourable outcomes. Conclusion: Increasing numbers of patients are being treated for MDR-TB each year with good treatment outcomes under national programme management in Viet Nam. However, there is a need to increase case detection—currently at 30% of the estimated 5100 MDR-TB cases per year, reduce adverse outcomes and improve monitoring and evaluation.

To determine the frequency and characteristics of patients with unsuccessful tuberculosis (TB) treatment.Random selection of TB case registers among all treatment units in Cambodia, two provinces in China, and Viet Nam. The data of two calendar years were analyzed to assess unsuccessful outcomes and their time of occurrence.Among the 33 309 TB patients, treatment was unsuccessful in respectively 10.1%, 3.0% and 9.1% of patients in Cambodia, China and Viet Nam. The risk of death was highest in Cambodia, higher among males than females, increased with age, and was more common among retreatment cases than new cases, and among patients with a high than a low sputum smear microscopy grade. Half of all deaths occurred in the first 2 months in Cambodia and within 11 weeks in China and Viet Nam. Median time to default was 3 months in Cambodia and Viet Nam, and about 2 months in China.Treatment was highly successful in the three study countries, with a low proportion of death and default. As the majority of defaulting occurs at the beginning of treatment, all countries should critically review their current policy of treatment support in this period.Déterminer la fréquence et les caractéristiques des patients dont le traitement de la tuberculose (TB) n’est pas couronné de succès.Sélection au hasard de registres de cas de TB dans toutes les unités de traitement du Cambodge, dans deux provinces de Chine et au Viet Nam. On a analysé les données de deux années-calendrier pour évaluer les résultats non couronnés de succès et le moment de leur survenue.Sur 33 309 patients TB, le traitement n’a pas été couronné de succès dans 10,1% au Cambodge, 3,0% en Chine et 9,1% au Viet Nam. Le risque de décès est le plus élevé au Cambodge, plus élevé chez les hommes que chez les femmes, va en croissant avec l’âge, est plus courant en cas de retraitement que pour les nouveaux cas et plus courant chez les patients dont le degré de positivité du frottis de crachats est élevé plutôt que faible. La moitié des décès sont survenus au cours des 2 premiers mois au Cambodge et dans les 11 premières semaines en Chine et au Viet Nam. La durée médiane avant l’abandon a été de 3 mois au Cambodge et au Viet Nam et d’environ 2 mois en Chine.Dans les trois pays qui ont fait l’objet de l’étude, le traitement est très fréquemment couronné de succès, avec une faible proportion de décès et d’abandons. Comme la majorité des abandons survient au début du traitement, tous les pays devraient réviser de façon critique leur politique actuelle de soutien au traitement au cours de cette période.Determinar la frecuencia del fracaso del tratamiento antituberculoso y las características de los pacientes.Se escogieron en forma aleatoria registros de casos de tuberculosis de todas las unidades de tratamiento en Camboya, dos provincias de la China y en Viet Nam. Se analizaron los datos de dos años civiles con el fin de evaluar los desenlaces desfavorables y el momento en que se presentaron.De los 33 309 pacientes con tuberculosis, un 10,1% presentó fracaso terapéutico en Camboya, un 3,0% en la China y un 9,1% en Viet Nam. El riesgo de muerte más alto se observó en Camboya, fue mayor en los hombres que en las mujeres, aumentó con la edad y fue más frecuente en los casos de retratamiento que en los casos nuevos y en los pacientes con una baciloscopia de esputo de alto grado que en los pacientes con un examen microscópico de bajo grado. La mitad de todas las defunciones ocurrió en los primeros 2 meses de tratamiento en Camboya y durante las primeras 11 semanas en la China y Viet Nam. La mediana del lapso hasta el abandono fue 3 meses en Camboya y Viet Nam y alrededor de 3 meses en la China.El tratamiento fue muy eficaz en los tres países estudiados, con una baja proporción de defunciones y abandonos. Dado que la mayoría de los abandonos ocurre al comienzo del tratamiento, todos los países deberían analizar de manera crítica su política vigente de apoyo al tratamiento durante este período.

National Tuberculosis Program, Viet Nam, 2008.To determine drug prescription adherence to national guidelines, to examine factors associated with an erroneous dosage of rifampin (RMP) and to evaluate the impact of an insufficient RMP dosage on treatment outcome.A representative sample of 30 treatment units was randomly selected. All patient treatment cards enrolled in these units were obtained, and data were double-entered and validated before calculating the adequacy of the individual drug prescriptions.Of 3412 tuberculosis treatment cards, 3225 (94.5%) had information on treatment regimen and the patient's weight. Treatment was successful in 89.4%. Prescriptions of tablets/vials conforming to recommendations were found for respectively 91.2%, 89.9%, 92.3% and 94.6% of the patients for RMP/isoniazid, pyrazinamide, ethambutol and streptomycin. Patients in the 25-39 kg weight bracket received insufficient dosages. This was almost entirely attributable to patients at the end of the weight bracket. Nevertheless, no significant association was found between treatment failure and death, body weight and insufficient RMP dosage.Adherence to national recommendations was high. RMP was given in insufficient dosage for patients at the end of a weight range bracket, but the under-dosage was small and did not measurably affect treatment outcome.Programme National de Tuberculose, Viet Nam 2008.Déterminer dans quelle mesure les prescriptions médicamenteuses adhèrent aux directives nationales, examiner les facteurs associés avec un dosage erroné de rifampicine (RMP) et évaluer l’impact d’un dosage insuffisant de RMP sur les résultats finaux du traitement.On a sélectionné au hasard un échantillon représentatif de 30 unités de traitement. Toutes les cartes de traitement des patients recrutés dans ces unités ont été recueillies, leurs données entrées en double et validées avant le calcul de l’adéquation des prescriptions individuelles des médicaments.Sur 3412 cartes de traitement de tuberculose, les informations sur le régime de traitement et le poids du patient étaient présentes dans 3225 (94,5%). Le traitement a été couronné de succès dans 89,4% des cas. On a observé des prescriptions de comprimés ou de vials conformes aux recommandations dans 91,2%, 89,9%, 92,3% et 94,6% des cartes respectivement pour la RMP/isoniazide, le pyrazinamide, l’éthambutol et la streptomycine. Les patients dans la classe de poids de 25 à 39 kg ont reçu un dosage insuffisant. Ceci est presque entièrement attribuable aux patients situés à l’extrémité de cette marge de poids. Néanmoins, on n’a observé aucune association significative entre l’échec et le décès, le poids corporel et un dosage insuffisant de RMP.L’adhésion aux recommandations nationales est marquée. La RMP a été administrée à un dosage insuffisant pour les patients situés à la fin d’une zone de poids, mais ce sous-dosage était peu marqué et n’a pas affecté de manière mesurable les résultats finaux du traitement.El Programa Nacional contra la Tuberculosis de Viet Nam, en el 2008.Determinar la conformidad de las recetas de medicamentos antituberculosos con las recomendaciones nacionales, a fin de examinar los factores que se asocian con una dosificación errónea de rifampicina (RMP) y evaluar la repercusión de una dosis demasiado baja de este medicamento en el desenlace terapéutico.Se escogió de manera aleatoria una muestra representativa conformada por 30 unidades de tratamiento. Se obtuvieron las tarjetas de tratamiento de todos los pacientes inscritos en estas unidades y se introdujeron en duplicado los datos y se validaron antes de calcular la adecuación de las recetas individuales.De las 3412 tarjetas de tratamiento antituberculoso que se examinaron, 3225 (94,5%) contenían información sobre la pauta terapéutica y el peso del paciente. El tratamiento fue exitoso en 89,4% de los casos. Se observó una concordancia de las recetas con las recomendaciones nacionales en materia de comprimidos o ampollas en 91,2% para RMP e isoniazida, 89,9% para pirazinamida, 92,3% para etambutol y en 94,6% para estreptomicina. Los pacientes con un peso corporal entre 25 y 39 kilos recibieron una dosificación demasiado baja, lo cual correspondió casi exclusivamente de los pacientes en el extremo de este intervalo ponderal. Sin embargo, no se encontró una asociación estadísticamente significativa entre el fracaso, la mortalidad, el peso corporal y una dosis demasiado baja de RMP.La conformidad de las recetas de medicamentos antituberculosos con las recomendaciones nacionales fue alta. La RMP se administró en dosis demasiado bajas a los pacientes que se encontraban en el extremo de un intervalo ponderal, pero esta infradosificación no fue excesiva y no ocasionó ninguna repercusión detectable en los desenlaces terapéuticos.

BACKGROUND: Tuberculosis (TB) prevalence surveys generally rely on a combination of screening methods to identify suspects eligible for sputum culture. OBJECTIVE: To assess the yield of screening methods applied in a recent prevalence survey in Viet Nam and estimate the proportion of TB cases missed due to incomplete participation. METHODS: TB suspects were identified based on self-reported TB history or productive cough by interview and chest X-ray (CXR). We calculated the case yield of these two screening methods by dividing the number of cases detected per method by the total number of cases detected. As not all participants underwent the full screening procedure, we recalculated the maximum yield of the screening methods using multiple imputation methods. RESULTS: The yield from screening by interview and CXR were respectively 38% and 91%. Adjusting for missing data by multiple imputation, we estimated that we missed 9.9% (95%CI 6.8-14.2) of expected TB cases. CONCLUSION: In prevalence surveys, screening by pre-structured interview is insufficient, and should be supplemented with CXR to achieve sufficient identification of TB cases. The effect of incomplete participation in the full screening procedure may be substantial and should be adjusted for in the analysis.

Summary Objective To assess health-seeking behaviour among adults with prolonged cough in a population-based, nationally representative sample in Vietnam. Methods Cross-sectional survey conducted from September 2006 to July 2007. All inhabitants aged ≥15 years were invited for screening for cough, history of tuberculosis (TB) treatment and chest X-ray (CXR) examination. TB suspects, defined as any survey participant with CXR abnormalities consistent with TB, or productive cough for more than 2 weeks or TB treatment either currently or in the preceding 2 years submitted sputum specimens for smear examination and culture and provided information on health-seeking behaviour in an in-depth interview. Results Of 94 179 persons participating in the survey, 4.6% had prolonged productive cough. Forty-four percentage of those had sought health care and reported pharmacies (35%), commune health posts (29%), public hospitals (24%) and private physicians (10%) as first point of contact. Only 7% had undergone sputum smear examination. Of TB suspects with prolonged productive cough, 2.9% were diagnosed with TB; 10.2% of these reported smear and 21.9% reported X-ray examination when visiting a health care facility. The average patient delay was 4.1 weeks (95% CI: 3.9–4.4) among cough suspects and 4.0 weeks (95% CI: 3.1–4.9) among TB cases. Conclusions In this Vietnamese survey, nearly half of persons with cough for more than 2 weeks had visited a health care provider. The commonest first health facility contacted was the pharmacy. Sputum smears were rarely examined, except in the provincial TB hospital. Our findings highlight the need to improve diagnostic practices by retraining health staff on the performance of sputum examination for TB suspects. Objectif: Evaluer le comportement de recours a la sante chez les adultes presentant une toux prolongee dans un echantillon national representatif de la population au Vietnam. Methodes: Enquete transversale menee de septembre 2006 a juillet 2007. Tous les habitants âges de ≥ 15 ans ont ete invites pour le depistage de la toux, l’historique du traitement de la tuberculose (TB) et l’examen radiographique du thorax (CXR). Les personnes suspectes de TB, definie comme tout participant a l’etude avec des anomalies CXR coherentes avec la TB, ou une toux productive de plus de deux semaines, ou un traitement en cours ou au cours des 2 annees precedentes pour la TB, ont soumis des echantillons d’expectoration pour l’examen des frottis et la culture et ont fourni les informations sur leurs comportements de recours a la sante dans une interview approfondie. Resultats: Parmi les 94.179 personnes participant a l’enquete, 4,6% avaient une toux productive prolongee. 44% de ceux-ci avaient sollicite des soins de sante et ont rapporte les pharmacies (35%), les postes de sante communaux (29%), les hopitaux publics (24%) et les medecins prives (10%) comme premiers points de contact. Seules 7% d’eux avaient subi un examen de frottis. Parmi les cas suspects de TB avec une toux productive prolongee, 2,9% ont ete diagnostiques avec la TB. 10,2% de ceux-ci avaient declare avoir eu un examen de frottis et 21,9%, un examen CXR lors de visite dans un etablissement de soins de sante. Le retard moyen des patients etait de 4,1 semaines (IC95%: 3,9 a 4,4) chez les suspects avec une toux et 4,0 semaines (IC95%: 3,1 a 4,9) chez les cas TB. Conclusions: Dans cette etude au Vietnam, pres de la moitie des personnes presentant une toux depuis plus de deux semaines avaient visite un fournisseur de soins de sante. Le centre de sante le plus couramment contacte en premier etait la pharmacie. Les frottis d’expectoration ont ete rarement examines, sauf dans l’hopital provincial de TB. Nos resultats soulignent la necessite d’ameliorer les pratiques de diagnostic par la reformation du personnel de sante sur la performance de l’examen des crachats des suspects TB. Objetivo: Evaluar el comportamiento de busqueda de salud de adultos con tos prolongada pertenecientes a una muestra nacional, representativa y basada en la poblacion en Vietnam. Metodos: Estudio croseccional realizado entre Septiembre del 2006 y Julio del 2007. Se invito a todos los habitantes con edades ≥15 anos a un cribado para tos, historia de tratamiento de TB y placa de Rayos X (PRX). Todos los sospechosos de padecer tuberculosis, definido como cualquier participante con anormalidades en la PRX consistentes con la tuberculosis, o tos productiva durante mas de 2 semanas, o recibiendo tratamiento para la tuberculosis en el momento del estudio o en los 2 anos anteriores, entregaron muestras de esputo para realizar un frotis y un cultivo y dieron informacion sobre su comportamiento de busqueda de salud durante una entrevista en profundidad. Resultados: De las 94,179 personas que participaron en el estudio, un 4.6% presentaban una tos productiva prolongada. Un 44% de aquellos que habian buscado cuidados sanitarios, lo habian hecho en farmacias (35%), puestos de salud comunitarios (29%), hospitales publicos (24%), y medicos privados (10%) como primer punto de contacto. Solo un 7% se habia realizado un frotis de esputo. De los sospechosos de TB con tos productiva prolongada, se diagnostico TB a un 2.9%. De estos, un 10.2% reporto haberse realizado un frotis y 21.9% reporto haberse realizado unos Rayos X durante la visita a un centro sanitario. El retraso promedio de los pacientes era de 4.1 semanas (95%IC: 3.9-4.4) entre los sospechosos de tos y 4.0 semanas (95%IC: 3.1-4.9) entre los casos de TB. Conclusiones: En este estudio Vietnamita, practicamente la mitad de las personas con una tos de mas de 2 semanas habia visitado algun proveedor sanitario. El establecimiento sanitario mas comunmente contactado fue la farmacia. Era raro que se examinaran los frotis de esputo, excepto en el hospital provincial para TB. Nuestros hallazgos resaltan la necesidad de mejorar las practicas diagnosticas, re-entrenando al personal sanitario en la realizacion del examen de esputo en sospechosos de TB.

OBJECTIVE: To estimate the prevalence of tuberculosis in Viet Nam with data from a population-based survey, compare it with the prevalence estimated by the World Health Organization, and identify major demographic determinants of tuberculosis prevalence. METHODS: A cross-sectional survey with multistage cluster sampling, stratified by urban, rural and remote areas, was done in 2006-2007 in 70 communes. All inhabitants aged > or = 15 years were invited for cough and chest X-ray examination. Participants with findings suggestive of tuberculosis provided sputum specimens for smear examination and culture. Point prevalence estimates, 95% confidence intervals and design effects were calculated. Confidence intervals and P-values were adjusted for the cluster design. FINDINGS: Of 114,389 adult inhabitants, 94 179 (82.3%) were screened. Of 87,314 (92.7%) screened by both questionnaire and chest X-ray, 3522 (4.0%) had productive cough, 518 (0.6%) had a recent history of tuberculosis and 2972 (3.4%) had chest X-ray abnormalities suggestive of tuberculosis. Sputum tests were done for 7648 participants. Sputum test, bacterial culture or both confirmed 269 tuberculosis cases, 174 of which were smear-positive. The prevalence rate of smear-positive tuberculosis was 145 per 100,000 (95% confidence interval: 110-180) assuming no tuberculosis in persons aged < 15 years. Prevalence was 5.1 times as high in men as in women, increased with age, was higher in rural than in urban or remote areas and showed a north-to-south gradient. CONCLUSION: In Viet Nam, the tuberculosis prevalence rate based on positive sputum smear tests was 1.6 times as high as previously estimated. Age and sex patterns were consistent with notification data. Tuberculosis control should remain a high priority in Viet Nam

Background Treatment outcomes of a high proportion of inpatients with multi-drug resistant tuberculosis (MDR-TB) were not reported to the Vietnamese National Tuberculosis Program because they received treatment outside of the green light committee (GLC) program. The study aimed (1) to describe the strengths and weaknesses of treatment of GLC and non-GLC MDR-TB patients as well as the factors influencing treatment completion and (2) to determine the incidence of adverse drug reactions. Results This cross-sectional study comprised two elements: (1) in-depth interviews with clinical doctors, hospital pharmacists; and focus group discussions with MDR-TB patients; and (2) a review of the charts of all GLC and non-GLC MDR-TB patients in 2010. A total of 282 MDR-TB patients were recruited, including 79(28 %) MDR-TB patients treated through the GLC program and 203(72 %) MDR-TB patients treated outside of the GLC program. The main strengths of GLC treatment were the supply of quality assured second line TB drugs, routine monitoring and clinical evaluation, free diagnostic tests and close clinical monitoring. The greatest barriers to patients treated outside of the GLC program was difficulty paying for second line TB drugs and other treatment costs. There was no significant difference between the incidence of adverse events among GLC (46.8 %) and non-GLC treated patients (52.2 %; p = 0.417). Among 143 patients who reported 226 adverse reaction events, arthralgia/joint pain (35.8 %), gastrointestinal (14.2 %), ototoxicity (8.4 %), cutaneous (6.6 %), and giddiness (5.8 %) were the most common. Conclusions The non-GLC MDR-TB patients face substantial barriers to treatment, and require greater support if they are to complete treatment and improve disease outcomes. Staff training about the management of adverse drug reactions is needed.

In 2009, the International Union Against Tuberculosis and Lung Disease (The Union) and Médecins sans Frontières Brussels-Luxembourg (MSF) began developing an outcome-oriented model for operational research training. In January 2013, The Union and MSF joined with the Special Programme for Research and Training in Tropical Diseases (TDR) at the World Health Organization (WHO) to form an initiative called the Structured Operational Research and Training Initiative (SORT IT). This integrates the training of public health programme staff with the conduct of operational research prioritised by their programme. SORT IT programmes consist of three one-week workshops over 9 months, with clearly-defined milestones and expected output. This paper describes the vision, objectives and structure of SORT IT programmes, including selection criteria for applicants, the research projects that can be undertaken within the time frame, the programme structure and milestones, mentorship, the monitoring and evaluation of the programmes and what happens beyond the programme in terms of further research, publications and the setting up of additional training programmes. There is a growing national and international need for operational research and related capacity building in public health. SORT IT aims to meet this need by advocating for the output-based model of operational research training for public health programme staff described here. It also aims to secure sustainable funding to expand training at a global and national level. Finally, it could act as an observatory to monitor and evaluate operational research in public health. Criteria for prospective partners wishing to join SORT IT have been drawn up.En 2009, L'Union Internationale contre la Tuberculose et les Maladies pulmonaires (L'Union) et Médecins sans Frontières Bruxelles-Luxembourg (MSF) ont commencé à élaborer un modèle orienté par les résultats pour la formation en recherche opérationnelle. En janvier 2013, l'Union et MSF ont rejoint le Programme Spécial de Recherche et de Formation des Maladies Tropicales (TDR) à l'OMS pour former une initiative baptisée « The Structured Operational Research and Training Initiative (SORT IT) » [Initiative structurée de recherche opérationnelle et de formation]. Celle-ci intègre la formation du personnel des programmes de santé publique et la conduite de recherche opérationnelle en fonction des priorités de leur programme. Les programmes SORT IT consistent en trois ateliers d'une semaine, étalés sur 9 mois, avec des étapes bien définies et des résultats attendus. Cet article décrit la vision, les objectifs et la structure des programmes SORT IT, notamment les critères de sélection des candidats, les projets de recherche qui peuvent être entrepris dans le temps imparti, la structure et les étapes du programme, le tutorat, le suivi et l'évaluation des programmes et les suites du programme en termes de recherche ultérieure, de publications et de conception/mise en œuvre de programmes de formation supplémentaire. Il y a un besoin croissant, national et international, de recherche opérationnelle et de renforcement des capacités dans ce domaine en santé publique. SORT IT vise à répondre à ce besoin en plaidant pour un modèle de formation en recherche opérationnelle basé sur les résultats du personnel de santé publique décrit ici. Il vise également à sécuriser un financement pérenne pour la formation des experts au niveau mondial et national. Enfin, il pourrait servir d'observatoire de suivi et d'évaluation de la recherche opérationnelle en santé publique. Les critères de recrutement de nouveaux partenaires potentiels qui souhaitent rejoindre SORT IT ont été élaborés.En el 2009, La Unión contra la Tuberculosis y las Enfermedades Respiratorias (La Unión) y Médecins sans Frontières de Bruselas y Luxemburgo comenzaron a desarrollar un modelo de capacitación en investigación operativa orientada por los resultados. En enero del 2013, ambas organizaciones se unieron a un Programa Especial de Investigación y Capacitación en Enfermedades Tropicales de la Organización Mundial de la Salud (OMS), con el fin de poner en marcha una iniciativa denominada SORT IT (acrónimo por

Objective To describe and analyse the prescription patterns and treatment outcomes of MDR-TB patients managed within Green Light Committee (GLC) and outside (non-GLC) the National TB programme in Viet Nam. Methods Retrospective cohort study with two elements: (i) in-depth interviews and focus group discussions with clinical doctors, hospital pharmacists, and the non-GLC patients with MDR-TB; (ii) review of treatment cards and patients' charts of all GLC and non-GLC patients with MDR-TB put on treatment during 2010. Results Of 282 patients with MDR-TB, comprising 79 (28%) GLC patients MDR-TB and 203 (72%) non-GLC patients with MDR-TB, were enrolled in the study. Treatment delay was significantly higher in the GLC group (12.8 days) than the non-GLC group (2.3 days), (P = 0.004). The success rate was significantly better in GLC patients (84.8%) than in non-GLC patients (53.7%) (P

OBJECTIVES To estimate the prevalence of infection with Mycobacterium tuberculosis and the annual risk of tuberculous infection (ARTI) and to compare this with the prevalence of tuberculosis (TB) over study clusters and households. METHODS A nationwide, stratified cluster sample survey was carried out in 2006-2007 in Viet Nam to assess the prevalence of infection with M. tuberculosis. A representative sample of children aged 6-14 years underwent a tuberculin skin test (TST) using the Mantoux method. RESULTS Of 23,160 children registered, 21,487 (92.8%) were tested and read and available for analysis. Using a cut-off point of 10 mm, the estimated prevalence of TST positivity was 16.7%, and the ARTI was 1.7% (95%CI 1.5-1.8). Higher infection rates were found in urban than in rural and remote areas, and infection rates increased with age. There was significant association between the prevalence of TB disease and infection at the cluster level (regression coefficient 0.54, 95%CI 0.06-1.01, P = 0.027, correlation coefficient R(2) 0.120). Children with a (recent) case of TB in the household were 1.6 times more likely to be TST-positive than children in households with no recent cases (P < 0.05). CONCLUSION The estimated nationwide ARTI was 1.7%. TST positivity was associated with the presence of a TB case in the household.

Addressing social determinants in the field of tuberculosis (TB) has received great attention in the past years, mainly due to the fact that worldwide TB incidence has not declined as much as expected, despite highly curative control strategies. One of the objectives of the World Health Organization Global Task Force on TB Impact Measurement is to assess the prevalence of TB disease in 22 high-burden countries by active screening of a random sample of the general population. These surveys provide a unique opportunity to assess socio-economic determinants in relation to prevalent TB and its risk factors. This article describes methods of measuring the socio-economic position in the context of a TB prevalence survey. An indirect measurement using an assets score is the most feasible way of doing this. Several examples are given from recently conducted prevalence surveys of the use of an assets score, its construction, and the analyses of the obtained data.

To assess health-seeking behaviour among adults with prolonged cough in a population-based, nationally representative sample in Vietnam.Cross-sectional survey conducted from September 2006 to July 2007. All inhabitants aged ≥15 years were invited for screening for cough, history of tuberculosis (TB) treatment and chest X-ray (CXR) examination. TB suspects, defined as any survey participant with CXR abnormalities consistent with TB, or productive cough for more than 2 weeks or TB treatment either currently or in the preceding 2 years submitted sputum specimens for smear examination and culture and provided information on health-seeking behaviour in an in-depth interview.Of 94 179 persons participating in the survey, 4.6% had prolonged productive cough. Forty-four percentage of those had sought health care and reported pharmacies (35%), commune health posts (29%), public hospitals (24%) and private physicians (10%) as first point of contact. Only 7% had undergone sputum smear examination. Of TB suspects with prolonged productive cough, 2.9% were diagnosed with TB; 10.2% of these reported smear and 21.9% reported X-ray examination when visiting a health care facility. The average patient delay was 4.1 weeks (95% CI: 3.9-4.4) among cough suspects and 4.0 weeks (95% CI: 3.1-4.9) among TB cases.In this Vietnamese survey, nearly half of persons with cough for more than 2 weeks had visited a health care provider. The commonest first health facility contacted was the pharmacy. Sputum smears were rarely examined, except in the provincial TB hospital. Our findings highlight the need to improve diagnostic practices by retraining health staff on the performance of sputum examination for TB suspects.

To study the association between TB and household expenditure in a nationwide TB prevalence survey in Viet Nam using nine household characteristics.To assess the prevalence of TB in Viet Nam, a nationwide stratified cluster sample survey was conducted from 2006 to 2007. Nine household characteristics used in the second Viet Nam Living Standards Survey (VLSS) were scored per household. In the VLSS dataset, we regressed these nine characteristics against household expenditure per capita, and used the coefficients to predict household expenditure level (in quintiles) in our survey and assess its relation with TB prevalence.The prevalence of bacteriologically confirmed TB was 307 per 100,000 population in persons aged ≥ 15 years (95%CI 249-366). After adjustment for confounders, prevalence was found to be associated with household expenditure level: the rate was 2.5 times higher for those in the lowest household expenditure quintile (95%CI 1.6-3.9) than those in the highest quintile.With a set of nine household characteristics, we were able to predict household expenditure level fairly accurately. There was a significant association between TB prevalence rates and estimated household expenditure level, showing that TB is related to poverty in Viet Nam.

To the Editor: In many countries, the private sector (practitioners not employed by government and nongovernment institutions, e.g., hospitals, pharmacies) is a major source of care, even for poor persons, and the area where services for the public are widely available (1,2). However, little information is available from high-incidence countries about the role of the private sector in tuberculosis (TB) detection and treatment (3). In Vietnam, ≤40% of all TB cases in Ho Chi Minh City (the largest city in Vietnam and with the highest rate of economic growth in the country) were estimated to be treated in the private sector (4), and half of all patients with a diagnosis of TB in the public sector (National Tuberculosis Program [NTP]) in Ho Chi Minh City initially sought help in the private sector (5). However, this estimate does not reflect private care in the entire country

Background Studies show that tuberculosis notification declines with increasing altitude. This can be due to declining incidence or declining case detection. In Vietnam notification rates of new smear-positive tuberculosis in the central mountainous provinces (26/100,000 population) are considerably lower than in Vietnam in general (69/100,000 population). In order to clarify whether this is explained by low incidence or low case detection, we aimed to assess the prevalence of new smear-positive tuberculosis among adults with prolonged cough in three mountainous provinces in central Vietnam. Methods A house-to-house survey of persons (≥ 15 years) was carried out in twelve randomly selected districts in 2003. Three sputum specimens were microscopically examined of persons reporting a prolonged cough (≥ 3 weeks). Case detection was assessed by the ratio between notification and prevalence. Results Of 68,946 included persons (95% response), 1,298 (1.9% 95%CI 1.8–2.2) reported a prolonged cough. Of these, eighteen were sputum smear-positive of whom two had had anti-tuberculosis treatment. The prevalence of new smear-positive tuberculosis was 27/100,000 (95%CI 11–44/100,000) and the notification rate was 44/100,000 among persons ≥ 15 years. The estimated case detection rate was 76%. Conclusion Low tuberculosis notification in this mountainous setting is probably a true reflection of low tuberculosis incidence. Possible causes for low incidence in mountainous areas include low transmission rates or altitude-related differences in pathology.

Setting: The National Tuberculosis (TB) Programme in Viet Nam and Ho Chi Minh City (HCMC). Objectives: To determine 1) at national level between 2011 and 2013, the relationship between human immunodeficiency virus (HIV) testing, uptake of TB-HIV interventions and adverse treatment outcomes among TB-HIV patients; and 2) in HCMC in 2013, patient characteristics associated with adverse outcomes. Design: An ecological study reviewing aggregate nationwide data and a retrospective cohort review in HCMC. Results: Nationwide, from 2011 to 2013, HIV testing increased in TB patients from 58% to 68% and antiretroviral therapy (ART) increased in TB-HIV patients from 54% to 63%. Adverse treatment outcomes in TB-HIV patients increased from 24% to 27%, largely due to transfer out (5–9% increase) and death. The Northern and Highland regions showed poor uptake of TB-HIV interventions. In HCMC, 303 (27%) of 1110 TB-HIV patients had adverse outcomes, with higher risks observed in those with previously treated TB, those diagnosed as HIV-positive before TB onset and those never placed on cotrimoxazole or ART. Conclusion: Despite improving HIV testing rates and TB-HIV interventions, adverse outcomes in TB-HIV patients remain at about 26%. Characteristics predicting higher risk of adverse outcomes must be addressed if Viet Nam wishes to end the TB epidemic by 2030.

Background The tuberculosis register is a critical data source for the information system of national tuberculosis control programs. From the information in the tuberculosis case register, it is possible to extend the standard analysis of age and sex characteristics among sputum smear-positive cases to all tuberculosis case categories. National tuberculosis programs might utilize such information to identify problems related to referral and access to diagnosis and treatment. Objectives Based on the electronic database we created, our objectives were to provide a detailed description of age and sex characteristics of tuberculosis patients at registration and to provide a comparison of age-specific sex characteristics among incident and prevalent sputum smear-positive cases. Methods A representative sample of tuberculosis case registers from 1 January 2003 to 31 December 2005 was selected in Cambodia, two provinces in China and Viet Nam. Age and sex characteristics of cases in the three separate prevalence surveys in the three jurisdictions (Cambodia: year 2002; China: year 2000; and Viet Nam: year 2006-2007) were obtained for comparison. Results A total 37,635 patients had been registered during the period in the selected units in the three countries. Cases were more frequently male in all three countries with 53%, 71%, and 69% in Cambodia, China, and Viet Nam, respectively. The ratios of the female-to-male odds in the notification system to that in the prevalence survey in smear-positive cases in Cambodia, China and Viet Nam were 2.1, 0.9, and 1.8, respectively. Because of the small proportion of extrapulmonary tuberculosis registered in China, we limited the analysis on age and sex distribution for extrapulmonary cases to Cambodia and Viet Nam. The proportion with extrapulmonary tuberculosis among all cases was 18.5% in Cambodia and 15.7% in Viet Nam, decreasing in frequency with increasing age. Conclusions Characteristics of patients greatly differed between countries and between patient categories. In Cambodia and Viet Nam, efforts should be made for improved case-finding of sputum smear-positive tuberculosis among males.

Background The tuberculosis case register is the data source for the reports submitted by basic management units to the national tuberculosis program. Our objective was to measure the data entry time required to complete and double-enter one record, and to estimate the time for the correction of errors in the captured information from tuberculosis case registers in Cambodia and Viet Nam. This should assist in quantifying the additional requirements in human resources for national programs moving towards electronic recording and reporting. Methods Data from a representative sample of tuberculosis case registers from Cambodia and Viet Nam were double-entered and discordances resolved by rechecking the original case register. Computer-generated data entry time recorded the time elapsed between opening of a new record and saving it to disk. Results The dataset comprised 22,732 double-entered records of 11,366 patients (37.1% from Cambodia and 62.9% from Viet Nam). The mean data entry times per record were 97.5 (95% CI: 96.2-98.8) and 66.2 (95% CI: 59.5-73.0) seconds with medians of 90 and 31 s respectively in Cambodia and in Viet Nam. The percentage of records with an error was 6.0% and 39.0% respectively in Cambodia and Viet Nam. Data entry time was inversely associated with error frequency. We estimate that approximately 118-person-hours were required to produce 1,000 validated records. Conclusions This study quantifies differences between two countries for data entry time for the tuberculosis case register and frequencies of data entry errors and suggests that higher data entry speed is partially offset by requiring revisiting more records for corrections.