An Innovative Public–Private Mix Model for Improving Tuberculosis Care in Vietnam: How Well Are We Doing?

Abstract

To improve tuberculosis (TB) care among individuals attending a private tertiary care hospital in Vietnam, an innovative private sector engagement model was implemented from June to December 2018. This included: (i) Active facility-based screening of all adults for TB symptoms (and chest x-ray (CXR) for those with symptoms) by trained and incentivized providers, with on-site diagnostic testing or transport of sputum samples, (ii) a mobile application to reduce dropout in the care cascade and (iii) enhanced follow-up care by community health workers. We conducted a cohort study using project and routine surveillance data for evaluation. Among 52,078 attendees, 368 (0.7%) had symptoms suggestive of TB and abnormalities on CXR. Among them, 299 (81%) were tested and 103 (34.4%) were diagnosed with TB. In addition, 195 individuals with normal CXR were indicated for TB testing by attending clinicians, of whom, seven were diagnosed with TB. Of the 110 TB patients diagnosed, 104 (95%) were initiated on treatment and 97 (93%) had a successful treatment outcome. Given the success of this model, the National TB Programme is considering to scale it up nationwide after undertaking a detailed cost-effectiveness analysis.

Coping with drug resistant tuberculosis alongside COVID-19 and other stressors in Zimbabwe: A qualitative study

“…Firstly, since TB diagnosis is the entry point into treatment and care, delays in diagnosis should be addressed by fostering collaborations between private and public healthcare sectors and alternative health providers such as traditional healers [ 42 , 54 ], investing resources into earlier diagnosis using rapid diagnostic technology, communicating current TB guidelines to all healthcare workers, raising community awareness about signs and symptoms of TB and benefits of early health seeking from public facilities. Secondly, given the health seeking patterns observed in this study and other studies [ 42 , 44 ], public-private partnerships may enhance TB case finding in Zimbabwe as has been demonstrated in Vietnam [ 55 , 56 ]. Private pharmacies and clinics will have to be trained on screening for TB and referral systems for sputum specimens to public health laboratories for TB testing.…”

Public–Private Mix (PPM) for Tuberculosis (TB) in Urban Health Systems in Least Developed, Low Income and Lower-Middle-Income Countries and Territories – A Systematic Review

“…Regarding the outcome ‘improved efficiency’, high TB treatment initiation was consistently reported across both model types (41, 52, 53, 81). Studies also reported lower loss to follow-up before treatment initiation among PPM PPs compared to non-PPM PPs (43).…”

“…For eight studies (27, 28, 33, 34, 48, 49, 57, 58, 60, 61, 70, 71, 84, 85, 87, 88), the research was reported across two publications each, which were merged and extracted as one study (Table 1 and Appendix 6). Most studies were from the WHO South-East Asia region (n=36, 65.4%) (30, 33, 36, 37, 40–42, 45, 47, 48, 50, 51, 54–56, 59, 60, 62, 64–67, 69, 74–76, 78–84, 86, 87, 89), followed by Eastern Mediterranean (n=7, 12.7%) (32, 43, 44, 46, 72, 73, 77), Western Pacific (n=6, 10.9%) (27, 31, 35, 52, 57, 70), African (n=4, 7.3%) (38, 39, 53, 68), and American (n=1, 1.8%) (63) regions. One study reported models from across three different countries and regions (29).…”

Special Issue “Innovation and Evidence for Achieving TB Elimination in the Asia-Pacific Region”

“…They added a mobile application to reduce dropouts in the cascade of care. This showed high rates of uptake in investigations by persons with possible symptoms of TB and of treatment by those diagnosed with TB [ 7 ]. In another study from Vietnam, Vo et al showed an increase of 8.5% in all forms of TB notifications through subsidized CXR screening and Xpert MTB/RIF testing among private practitioners, with support of improved reporting to the national TB program [ 8 ].…”