Leveraging New Tools for TB Testing in Vietnam
Since 1998, the U.S. Centers for Disease Control and Prevention (CDC) has worked with the Vietnam Ministry of Health to support and expand programs that target priority diseases, including tuberculosis (TB). In 2020, Vietnam reported 172,000 cases of TB and ranked 10th globally among countries with the highest burdens of TB. Although the burden remains high, TB prevalence has declined by over 35 percent since 2007 and TB mortality dropped by 41 percent between 2015 to 2020 due to use of innovative tools and techniques to reduce TB . These innovative techniques – rapid molecular testing and portable chest x-ray capabilities – have helped Vietnam continue to see progress in the fight against TB amidst global challenges.
According to the Vietnam National TB Program (NTP), the country is focused on applying these new approaches to priority areas, including remote provinces to accelerate progress towards national targets for ending TB. To help meet these targets, and to mitigate the impact of the ongoing COVID-19 pandemic on TB programs, CDC Vietnam and partners launched a project in 2021 to make two new technological innovations tools available to communities. This includes 1) TrueNat, a mobile, near point-of-care rapid molecular test that can diagnose TB within an hour, and 2) portable chest radiography (CXR) using a Fujifilm Xair device. Both devices are designed for use in low-resource settings with rugged portability and ease of use in mind – ideal for reaching individuals in remote areas of Vietnam. CDC Vietnam implemented this project in partnership with the NTP and CRDF-Global and Friends for International Tuberculosis Relief (FIT) with support from the Coronavirus AID, Relief, and Economic Security (CARES) Act.
“We Will Find Them”
Lai Chau, a rural northwest province with language and cultural differences, is one of 11 provinces in Vietnam (out of 63) with the lowest treatment rates for new and previously treated TB and low notification rates of new cases. To address the historical gaps in TB programing, experts from CDC Vietnam joined NTP staff and the FIT implementation team on a case finding trip to the remote area.
Working closely with area partners, the project team screened over 5,600 residents for TB using the portable CXR device. Community members were also screened for other health conditions, including high blood pressure, diabetes, asthma, and chronic obstructive pulmonary disease. CDC Vietnam, the NTP and FIT also provided assistance and recommendations for safely implementing TB screenings during COVID-19 using proven infection prevention and control protocols and biosafety best practices. The rate of persons with a positive test detected by TrueNat suggested a much higher TB prevalence than that reported in the local estimate. Preliminary results showed that 21 percent of participants eligible for tuberculin skin testing (TST) were found to have a positive TST and eligible for TB preventive treatment – with both interventions serving as a key strategy to identifying, treating, and preventing further TB infection.
Considering Lai Chau’s remote location, and the community’s limited access to health care services, CDC Vietnam, the NTP and FIT took steps to alleviate the community’s challenges access care, including the provision of travel stipends for patient treatment and the continued use of TrueNat and portable CXR as convenient and feasible technologies there in the community. Commenting on the project, Dr. Dung Tran, TB lab program officer for CDC Vietnam said, “CDC Vietnam’s partnership with the Government of Vietnam strives to tackle TB on numerous fronts, and we’re proud to have been a part of the progress Vietnam has made thus far. This project is another example of CDC’s efforts to provide support and direct technical assistance that will improve the capacity of Vietnam’s health care system. Piece by piece, it will accelerate progress towards Vietnam’s TB elimination targets.”.
Applying Lessons Learned
With the impressive performance of TrueNat and the portable CXR in the field, CDC Vietnam and partners were able to provide innovative tools for TB screening and train public health staff on how to interpret and troubleshoot the technologies. Use of these technologies will also help to accurately assess district-level TB disease trends. Lessons learned in Lai Chau will be applied to further TB screening campaigns planned in remote ethnic minority communities in three additional provinces.
Together, CDC Vietnam and partners successfully implemented new technologies, identified opportunities for improvement, and implemented plans to sustain support to communities. By collaborating with all levels of government and providing community-based support and feedback, CDC Vietnam continues to serve as a valued partner in strengthening Vietnam’s capacity for TB care and prevention.