Introduction of the Simple One-Step stool Xpert Ultra method to detect TB in children and adults.

SETTING: In 2020, the National TB Programme (NTP) of Vietnam conducted an implementation pilot of the Simple One-Step (SOS) stool processing method using Xpert® MTB/RIF Ultra (Ultra) among children and people living with HIV (PLHIV) with signs and symptoms of TB.DESIGN and OBJECTIVES: Using data from this pilot and collecting information on healthcare workers´ (HCWs) perceptions, we assessed the feasibility, acceptability and potential impact of routine stool testing for TB.RESULTS: HCWs perceived collection of stools from children as least stressful of all sample types, stool processing as acceptable and the SOS stool method as easy to perform. After a 3-month induction period, the proportion of initial non-determinate Ultra stool tests was less than 5%. Combined Ultra testing of a respiratory sample and stool resulted in an increase in the proportion of bacteriologically confirmed TB among PLHIV and children by respectively 4.1% (95% CI 1.6-6.6) and 3.9% (95% CI 1.6-6.2). Among children, Mycobacterium tuberculosis was more often detected in stool (26.1%) than in respiratory samples (23.4%) (P = 0.06), including one child with rifampicin resistance.CONCLUSION: Stool testing can be feasibly implemented both in adult PLHIV and in children in routine settings, providing a non-invasive alternative sample type for the diagnosis of TB for patients who cannot produce sputum.

Does BCG vaccination protect against infection with M. tuberculosis?

BACKGROUND: Protection against infection by the bacille Calmette-Guérin vaccine against Mycobacterium tuberculosis remains a subject of controversy. We investigated the association between BCG vaccination at birth and infection by M. tuberculosis.MATERIAL and METHODS: This was a secondary analysis of data from tuberculin skin test (TST) surveys in Vietnamese schoolchildren between 1988 and 2001. We investigated whether a BCG scar was associated with a lower prevalence of TST positivity, adjusting for BCG-induced variation by varying cut-off values for a positive TST.RESULTS: We found a positive association between BCG scar and TST positivity. The strength of the association decreased with increasing TST cut-off values; however, it never inverted significantly, irrespective of geographic region and survey year.CONCLUSION: In Vietnam, BCG vaccination was not associated with reduced M. tuberculosis infection prevalence as measured using TST. This in contrary to a similar study conducted in Tanzania. These contradictory findings may be explained by geographical differences and the relatively high prevalence in Vietnam of the M. tuberculosis Beijing genotype, which is reported to be capable of circumventing BCG-induced immunity.

Palliative care and symptom relief for people affected by multidrug-resistant tuberculosis.

The World Health Organization (WHO) defines palliative care as the prevention and relief of the physical, psychological, social and spiritual suffering of adults and children with life-threatening illnesses and psycho-social support for their families. Palliative care and symptom relief (PCSR) also addresses suffering in nonlife-threatening situations such as after cure. PCSR should never be considered a substitute for tuberculosis (TB) prevention and treatment, but should be accessible by everyone in need. PCSR can reduce suffering and improve quality of life of patients with end-stage chronic illnesses while reducing costs for health care systems and providing financial risk protection for patients' families. It also may help enable patients to adhere to long and noxious treatments and thereby reduce mortality and help protect public health. Basic PCSR can be taught easily to TB specialists as well as primary care clinicians and delivered in hospitals, clinics or patients' homes combined with infection control. For these reasons, integration of PCSR into multidrug-resistant (MDR) and extensively drug-resistant TB (XDR-TB) treatment programs is medically and morally imperative. We propose an essential package of PCSR for people with M/XDR-TB that includes a set of safe, effective and inexpensive medicines and equipment, social supports for patients and caregivers living in extreme poverty, and necessary human resources. The package aligns with WHO guidance on programmatic management of drug-resistant (DR) TB and should be universally accessible by people affected by M/XDR-TB. We also describe the ethical practice of PCSR for people with M/XDR-TB and identify needed areas of research in PCSR for people with M/XDR-TB.

National tuberculosis patients cost survey: research findings lead to change in policy and practice, Viet Nam.

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.

Prevalence and associated factors of diabetes mellitus among tuberculosis patients in Hanoi, Vietnam.

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.

Measuring catastrophic costs due to tuberculosis in Viet Nam.

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.

Economic burden of multidrug-resistant tuberculosis: a multicenter study across Vietnamese regions.

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.

Prevalence of latent tuberculous infection among adults in the general population of Ca Mau, Viet Nam.

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.

Costs of providing tuberculosis diagnosis and treatment services in Viet Nam.

OBJECTIVE: To estimate the cost of providing tuberculosis (TB) diagnosis and treatment packages at different levels of health facilities in Viet Nam. DESIGN: This was a retrospective costing study from the providers' perspective using a standard costing approach. We included typical services for TB diagnosis and treatment based on standard protocols. RESULTS: The least expensive TB service was the 6-month isoniazid preventive therapy regimen for latent tuberculous infection provided by district health centres (US$7.20-14.30, accounting for 0.3-0.7% of Viet Nam's per capita gross domestic product [GDP] of US$2052.30 in 2014). The cost of diagnosing and treating a patient with drug-susceptible TB (the most common type of TB) ranged between US$51.20 and US$180.70, and represented 2.5-8.8% of Viet Nam's per capita GDP in 2014. The most expensive TB service was the diagnosis and treatment of a multidrug-resistant TB case (US$1568.20-2391.20), accounting for 76.4-116.5% of Viet Nam's per capita GDP in 2014). CONCLUSION: The cost of TB diagnosis and treatment services in Viet Nam varied according to level of health facility, type of TB, different costing options, and different staff cost scenarios.

Latent tuberculous infection in household contacts of multidrug-resistant and newly diagnosed tuberculosis.

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.

Collaborative activities and treatment outcomes in patients with HIV-associated tuberculosis in Viet Nam.

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.

Contexte : Le programme national tuberculose (TB) au Viet Nam et à Ho Chi Minh ville (HCMC).Objectifs : Déterminer 1) au niveau national entre 2011 et 2013, la relation entre le test pour le virus de l'immunodéficience humaine (VIH), l'utilisation des interventions TB-VIH et les mauvais résultats du traitement de la TB parmi les patients TB-VIH, et 2) à HCMC en 2013, les caractéristiques des patients associées à un mauvais résultat.Schéma : Une étude écologique revoyant les données nationales agrégées et une étude de cohorte rétrospective dans HCMC.Résultats : Au niveau national, le test VIH est passé de 58% à 68% chez les patients tuberculeux et le traitement antirétroviral (ART) est passé chez les patients TB-VIH de 54% à 63% entre 2011 et 2013. Les mauvais résultats du traitement chez les patients TB-VIH ont augmenté de 24% à 27%, largement à cause des transferts (de 5% à 9%) et des décès. Les régions du Nord et des Highlands ont montré une faible utilisation des interventions TB-VIH. A HCMC, 303 (27%) patients TB-VIH sur 1110 ont eu un mauvais résultat avec un risque plus élevé observé parmi ceux qui avaient déjà eu un traitement de TB, ceux dont le diagnostic de VIH précédait l'apparition de la TB et ceux qui n'avaient jamais bénéficié du traitement par cotrimoxazole et de l'ART.Conclusion : En dépit de meilleurs taux de tests VIH et d'interventions TB-VIH, près de 26% des patients TB-VIH ont de mauvais résultats du traitement de la TB. Les facteurs de prédiction d'un risque plus élevé de mauvais résultats doivent être pris en compte si le Viet Nam souhaite mettre fin à l'épidémie de TB d'ici 2030.

Marco de referencia: El Programa Nacional contra la Tuberculosis (TB) en Viet Nam y la ciudad de Ho Chi Minh.Objetivos: 1) Definir a escala nacional la relación entre la aceptación de la prueba diagnóstica de la infección por el virus de la inmunodeficiencia humana (VIH), las intervenciones conjuntas contra la TB y el VIH y los desenlaces desfavorables del tratamiento antituberculoso en pacientes aquejados de esta coinfección, del 2011 y el 2013; y 2) determinar las características de los pacientes que se asocian con los desenlaces terapéuticos adversos en la ciudad de Ho Chi Minh.Método: Se llevó a cabo un estudio ecológico, en el cual se examinaron los datos nacionales agregados y un estudio retrospectivo de cohortes en la ciudad de Ho Chi Minh.Resultados: A escala nacional, del 2011 al 2013 se observó un aumento de 58% a 68% en la práctica de la prueba del VIH a los pacientes con diagnóstico de TB y de 54% a 63% en la administración del tratamiento antirretrovírico (ART) a los pacientes coinfectados. Los desenlaces terapéuticos desfavorables en los pacientes coinfectados aumentaron de 24% a 27%, debido sobre todo a las transferencias a otros centros (de 5% a 9%) y a los fallecimientos. En los regions del norte y Highland se observó una baja aceptación de las intervenciones conjuntas contra la TB y el VIH. En la ciudad de Ho Chi Minh, 303 de los 1110 pacientes coinfectados (27%) presentaron desenlaces adversos y el riesgo fue mayor en los pacientes con antecedente de tratamiento antituberculoso, en pacientes cuyo diagnóstico de infección por el VIH precedió el comienzo de la TB y en los pacientes que nunca se inscribieron al tratamiento con cotrimoxazol o ART.Conclusión: Pese a los progresos en la práctica de la prueba diagnóstica de la infección por el VIH y las intervenciones conjuntas contra la TB y el VIH, la tasa de desenlaces terapéuticos desfavorables alcanza un 26% en los pacientes coinfectados. Es preciso abordar los factores que favorecen el mayor riesgo de desenlaces adversos, si se desea poner fin a la epidemia de TB en el 2030 en Viet Nam.

Management and treatment outcomes of patients enrolled in MDR-TB treatment in Viet Nam.

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.

Contexte : La prise en charge de la tuberculose (TB) pharmacorésistante au Viet Nam a bénéficié d'une accélération considérable depuis 2009.Objectifs : Documenter le nombre annuel de patients enrôlés pour un traitement de TB multirésistante (TB-MDR) entre 2010 et 2014, et déterminer les caractéristiques et les résultats du traitement des patients qui l'out commencé entre 2010 et 2012.Schéma : Etude rétrospective de cohorte basée sur les rapports nationaux et les données du système national de données électroniques pour la TB pharmacorésistante.Résultats : Le nombre de patients enrôlés chaque année pour traitement de TB-MDR a augmenté de 97 en 2010 à 1522 en 2014. La majorité des patients étaient des hommes d'âge moyen qui avaient une atteinte pulmonaire et chez qui un protocole de retraitement avait échoué ; 77% d'entre eux avaient reçu au moins deux traitements de TB. De bons résultats (guérison et achèvement du traitement) ont été obtenus chez 73% des patients. Les résultats défavorables incluaient les sujets perdus de vue (12,5%), les décès (8%) et les échecs (6,3%). Avoir eu plus de deux traitements préalables et être positif pour le virus de l'immunodéficience humaine étaient associés à des résultats défavorables.Conclusion : Un nombre croissant de patients est traité pour TB-MDR chaque année dans le cadre du programme national de prise en charge au Viet Nam, avec de bons résultats. Cependant, il est nécessaire d'augmenter la détection des cas (actuellement seulement 30% des 5100 cas de TB-MDR estimés par an), de réduire la proportion de résultats défavorables et d'améliorer le suivi et l'évaluation.

Marco de referencia: Desde el 2009, se ha ampliado rápidamente la escala del tratamiento de la tuberculosis (TB) farmacorresistente en el marco del programa nacional de Viet Nam.Objetivos: Documentar el número de pacientes inscritos cada año en el tratamiento de la TB multidrogorresistente (TB-MDR) del 2010 al 2014 y determinar los desenlaces terapéuticos y sus características en los pacientes que iniciaron tratamiento del 2010 al 2012.Método: Fue este un estudio retrospectivo de cohortes a partir de los registros y los datos del sistema electrónico nacional de datos sobre la TB farmacorresistente.Resultados: El número de pacientes incorporados cada año al tratamiento de la TB-MDR aumentó de 97 en el 2010 a 1522 en el 2014. En su mayoría, se trató de hombres de mediana edad con afectación pulmonar, en quienes había fracasado una pauta de retratamiento y de los cuales el 77% había recibido dos o más ciclos de tratamiento antituberculoso. El 73% de pacientes alcanzó desenlaces favorables (curación y compleción del tratamiento). Los desenlaces desfavorables observados fueron la pérdida durante el seguimiento (12,5%), la muerte (8%) y el fracaso terapéutico (6,3%). El hecho de haber recibido dos o más ciclos de tratamiento antituberculoso y la positividad frente al virus de la inmunodeficiencia humana se asociaron con los desenlaces desfavorables.Conclusión: Cada año, un mayor número de pacientes recibe tratamiento por TB-MDR en el marco del programa nacional contra la TB y alcanza desenlaces terapéuticos favorables en Viet Nam. Sin embargo, es preciso aumentar la detección de casos (que alcanza actualmente el 30% de los 5100 casos estimados de TB-MDR por año), disminuir los desenlaces desfavorables y mejorar el seguimiento y la evaluación.

The role of macroscopic sputum quality assessments to optimise sputum testing for tuberculosis.

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.

The effects of placing an operational research fellow within the Viet Nam National Tuberculosis Programme.

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 (n = 8) and practice (n = 8), and these in turn improved programme performance. Many papers also contributed important evidence for better programme planning. Highly motivated OR fellows embedded within NTPs can facilitate high-quality research and research uptake.

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 (n = 8) et les pratiques (n = 8), et ceci à son tour a amélioré la performance du PNT. De nombreux articles ont également contribué dans une manière importante à une meilleure planification du PNT. Des responsables de RO très motivés incorporés au sein des PNT peuvent faciliter une recherche de qualité élevée et l'adoption de recherche.

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 (n = 8) y las prácticas (n = 8) y estas innovaciones mejoraron el desempeño del PNT. Muchos artículos aportaron además datos importantes para optimizar la planeación del PNT. La incorporación a los PNT de becarios en investigación operativa, muy motivados, favorece la realización de investigaciones de gran calidad y la aplicación práctica de sus resultados.

Evaluation of mobile digital light-emitting diode fluorescence microscopy in Hanoi, Viet Nam.

SETTING: Hanoi Lung Hospital, Hanoi, Viet Nam. OBJECTIVE: To compare the accuracy of CellScopeTB, a manually operated mobile digital fluorescence microscope, with conventional microscopy techniques. DESIGN: Patients referred for sputum smear microscopy to the Hanoi Lung Hospital from May to September 2013 were included. Ziehl-Neelsen (ZN) smear microscopy, conventional light-emitting diode (LED) fluorescence microscopy (FM), CellScopeTB-based LED FM and Xpert(®) MTB/RIF were performed on sputum samples. The sensitivity and specificity of microscopy techniques were determined in reference to Xpert results, and differences were compared using McNemar's paired test of proportions. RESULTS: Of 326 patients enrolled, 93 (28.5%) were Xpert-positive for TB. The sensitivity of ZN microscopy, conventional LED FM, and CellScopeTB-based LED FM was respectively 37.6% (95%CI 27.8-48.3), 41.9% (95%CI 31.8-52.6), and 35.5% (95%CI 25.8-46.1). The sensitivity of CellScopeTB was similar to that of conventional LED FM (difference -6.5%, 95%CI -18.2 to 5.3, P = 0.33) and ZN microscopy (difference -2.2%, 95%CI -9.2 to 4.9, P = 0.73). The specificity was >99% for all three techniques. DISCUSSION: CellScopeTB performed similarly to conventional microscopy techniques in the hands of experienced TB microscopists. However, the sensitivity of all sputum microscopy techniques was low. Options enabled by digital microscopy, such as automated imaging with real-time computerized analysis, should be explored to increase sensitivity.

The fourth national anti-tuberculosis drug resistance survey in Viet Nam.

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.

Western Pacific Regional Green Light Committee: progress and way forward.

The Western Pacific Regional Green Light Committee (rGLC WPR) was established in 2011 to promote the rational scale-up of programmatic management of drug-resistant tuberculosis (PMDT). We reflect on its achievements, consider the challenges faced, and explore its potential future role. Achievements include the supervision and support of national PMDT action plans, increased local ownership, contextualized guidance, and a strong focus on regional capacity building, as well as a greater awareness of regional challenges. Future rGLC activities should include (1) advocacy for high-level political commitment; (2) monitoring, evaluation, and supervision; (3) technical support and contextualized guidance; and (4) training, capacity building, and operational research. Regional activities require close collaboration with both national and global efforts, and should be an important component of the new Global Drug-resistant TB Initiative.

First national tuberculin survey in Viet Nam: characteristics and association with tuberculosis prevalence.

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.