Enhanced Private Sector Engagement for Tuberculosis Diagnosis and Reporting through an Intermediary Agency in Ho Chi Minh City, Viet Nam

Abstract

Under-detection and -reporting in the private sector constitute a major barrier in Viet Nam’s fight to end tuberculosis (TB). Effective private-sector engagement requires innovative approaches. We established an intermediary agency that incentivized private providers in two districts of Ho Chi Minh City to refer persons with presumptive TB and share data of unreported TB treatment from July 2017 to March 2019. We subsidized chest x-ray screening and Xpert MTB/RIF testing, and supported test logistics, recording, and reporting. Among 393 participating private providers, 32.1% (126/393) referred at least one symptomatic person, and 3.6% (14/393) reported TB patients treated in their practice. In total, the study identified 1203 people with TB through private provider engagement. Of these, 7.6% (91/1203) were referred for treatment in government facilities. The referrals led to a post-intervention increase of +8.5% in All Forms TB notifications in the intervention districts. The remaining 92.4% (1112/1203) of identified people with TB elected private-sector treatment and were not notified to the NTP. Had this private TB treatment been included in official notifications, the increase in All Forms TB notifications would have been +68.3%. Our evaluation showed that an intermediary agency model can potentially engage private providers in Viet Nam to notify many people with TB who are not being captured by the current system. This could have a substantial impact on transparency into disease burden and contribute significantly to the progress towards ending TB.

Socio-protective effects of active case finding on catastrophic costs from tuberculosis in Ho Chi Minh City, Viet Nam: a longitudinal patient cost survey

“…Patients in the PCF districts received routine care as per national treatment guidelines. The intervention is described in detail elsewhere [ 20 , 21 ].…”

Assessing private provider perceptions and the acceptability of video observed treatment technology for tuberculosis treatment adherence in three cities across Viet Nam

“…We estimated an average rating difference between private providers of 0.9 and a population variance of 4 based on initial results from piloting the survey instrument and intentionally oversampled for the eventuality of post-hoc exclusion of unclear or invalid responses. We invited all eligible private providers who were partnering with Friends for International Tuberculosis Relief (FIT) on the scale-up of the private provider interface agency model [ 32 ]. We additionally used chain-sampling; interviewees and other health care workers who were recruited for our study referred us to other private providers who might be eligible to participate.…”

“…The private sector represents the first point of contact for 70% of persons with TB, and 40% of TB patients are treated exclusively by the private sector [ 31 ]. A private provider interface agency model piloted in Ho Chi Minh City (HCMC) between October 2017 and March 2019 discovered 1,112 TB patients being treated in the private sector in two districts of the city [ 32 ]. As such, alongside case management, VOT may have the secondary benefit of elucidating the TB burden managed by the private sector through documented treatment monitoring.…”

Progress toward Developing Sensitive Non-Sputum-Based Tuberculosis Diagnostic Tests: the Promise of Urine Cell-Free DNA

“…Over the last ten years, a variety of primarily sputum-based molecular TB diagnostic tests have received World Health Organization (WHO) endorsement and have become commercially available, such as Xpert MTB/RIF (Cepheid, USA), Xpert MTB/RIF Ultra (Ultra) (Cepheid, USA), and Truenat MTB/RIF (Molbio Diagnostics, India) (6). Unique product delivery models have been explored in an attempt to increase access to these new TB diagnostic technologies (7,8), although implementation and scale-up have posed major challenges (9). At present, however, most emerging TB technologies, including TB biomarkers generally (5) and circulating cell-free DNA (cfDNA), specifically (10, 11), do not meet the published diagnostic accuracy criteria specified in WHO's target product profiles (TPPs) (12).…”