DTBE in Vietnam
Capital City: Hanoi
Area*:331,114 sq. km. (127,243 sq. mi.)
Population (est.), 2011*: 90 million
Estimated TB Incidence, 2010**: 199/100,000
Estimated TB Prevalence, 2010**: 334/100,000
Adult HIV Prevalence Rate, 2009***: 0.4%
Number of people living with HIV (PLHIV), 2009***:280,000
Percent of tested TB patients who were HIV+, 2010**: 8%
**Source: WHO Global TB Control Report 2011
***Source: UNAIDS, Report on the Global AIDS Epidemic, 2010
Since 1997,CDC’s Division of Tuberculosis Elimination (DTBE) has collaborated with the Vietnam National Tuberculosis Program (NTP) and providedtechnical assistance for operations research (OR) training, epidemiological research studies,management training, and laboratory studies. In 2001, this effort was expanded to addressTB/HIV co-infection. CDC/DTBE’s Regional TB Technical Advisor stationed in Bangkok, Thailand works closely with the Thai Ministry of Public Health (MOPH)-U.S. CDC collaboration (TUC) Southeast Asia Regional TB Program to provide technical support for Vietnam. Program staff also provide technical assistance to other countries in the region, including Laos and Cambodia, and to World Health Organization (WHO) regional offices in New Delhi and Manila. CDC/DTBE is focused on providing technical assistance and resources for the implementation of a national initiative for TB/HIV service integration, operations research, capacity building and training for the National TB Program, and technical support to other U.S. Government (USG) and Vietnam staff.
Recent Accomplishments & Ongoing Collaborations
Program Strengthening and Epidemiology
TB Risk Assessment of Staff in Hospitals: CDC/DTBE is conducting an assessment of the risk of TB among hospital staff, including staff of outpatient HIV care facilities. This evaluation assessed the magnitude of risk in these outpatient settings and serves as a baseline for future infection control interventions. The results will guide infection control implementation in outpatient settings and will determine what is needed to protect health care workers from TB and guide rational scale-up of infection control interventions.
Infection Control Training and Assessment: CDC/DTBE is providing training on TB infection control including hands-on training in conducting detailed facility assessments for selected hospitals.
MDR TB, TB/HIV, and Other At-Risk Populations
Intensified TB case finding for people living with HIV (PLHIV): CDC/DTBE led a cross-sectional study (Improving Diagnosis of TB in HIV-Infected Persons: The ID-TB/HIV Study), enrolling more than 2,000 PLHIV from eight anti-retroviral therapy (ART) clinics in Cambodia, Thailand, and Vietnam to determine the best method for screening and diagnosing TB in PLHIV. The study found that using previously recommended screening approaches failed to detect more than two-thirds of patients with TB disease. However, screening PLHIV for TB using a combination of three symptoms detected almost all cases (93%) among this population. The presence of one or more symptom (cough, fever, or night sweats) is a positive symptoms screen, whereas absence of all symptoms is a negative symptom screen. Patients with a positive symptom screen need further evaluation to accurately diagnose TB disease. Patients with a negative symptom screen have TB disease reliably ruled-out (97% without TB had no symptoms), allowing isoniazid preventive therapy (IPT) to be started more quickly. In follow up to this study, CDC/DTBE and WHO collaborated on a meta-analysis which led to a change in WHO’s international guidelines for screening for TB among PLHIV. These updated guidelines are available here: WHO Guidelines for ICF and IPT.
TB Screening and Isoniazid Preventive Therapy in People with HIV: In follow up to the intensified TB case finding study described above, national TB and HIV programs are revising their TB screening guidelines and recommending IPT. CDC is supporting implementation and evaluation of the newly defined TB screening algorithm, along with isoniazid preventive therapy, at selected demonstration sites. The project will evaluate how well the evidence-based screening approach works in routine program use, acceptability to clinicians and barriers to implementation, and the uptake of isoniazid preventive therapy. Similar evaluations are also being done in Thailand and Cambodia.
IPT in HIV-Infected Persons: In 2007, the Vietnam Ministry of Health (MOH) adopted a new policy supporting the use of IPT in HIV-infected patients. Before transforming this policy into national practice, the MOH developed a plan to evaluate models for IPT in USG Focus provinces. In 2008-2009, CDC assisted the Vietnam Ministry of Health in implementing a pilot program for IPT in HIV-infected patients by monitoring current patient recruitment, enrollment and data collection procedures in An Giang and Hai Phong provinces. Findings from the pilot project were shared in late 2009 and are being incorporated into new revised national guidelines for IPT.
Evaluation of Risk Factors for High Early Mortality Among HIV-Infected TB Patients: Using data from Ho Chi Minh City, CDC staff and colleagues are evaluating risk factors for the high rates of death among TB/HIV patients, including the role of anti-retroviral therapy and cotrimoxazole therapy (given to patients with HIV to prevent opportunistic infections) in reducing the risk of death.