[CNS video] Viet Nam is not only a high burden country for tuberculosis (TB) but also for multidrug-resistant TB (MDR-TB) as well as HIV. Despite challenges, Viet Nam has made significant progress in fighting TB country-wide. For instance, the treatment success rate for MDR-TB hovers around 48% for most of the world, but Viet Nam is among the five countries where treatment success rate for MDR-TB has touched 70%. Despite progress, formidable challenges remain.Citizen News Service (CNS) spoke with Dr Nguyen Viet Nhung, who leads the National TB Programme of Viet Nam, and is also the Director of National Lung Hospital (click here to watch the video of this interview).
If we do not act now, it will be too late!
Dr Nhung said: "At the last year’s Global Health Security Forum, MDR-TB was one of the hot topics and need for effective advocacy came out strong. If we do not act now, it will be too late!"
"In Vietnam we had set up the MDR-TB control programme as a priority component of broader TB control programme. We cannot forget regular TB control because more than 95% of new TB patients are still drug susceptible (routine anti-TB drugs work for most patients, and they are not resistant to anti-TB drugs). We have a very effective firstline drug regimen for them. So we try to detect them as early as possible, and help stop infection transmission, reduce incidence and prevent MDR-TB. Early diagnosis is just one step: it is equally important to provide the right anti-TB regimen which is effective for a particular patient. Then we need to ensure the patient completes effective anti-TB regimen and get cured: so we need to provide adequate counselling for every patient so that patient is able to adhere to the regimen and also it helps in preventing infection transmission. For drug resistance TB, it is very important to prevent it, detect drug resistance and treat it with effective regimen."
Only 4% of newly detected TB patients have drug resistance in Viet Nam. But 23% of previously-treated TB cases are of MDR-TB.
Pilot of 9 month MDR-TB regimen begins on 1st September 2015
Viet Nam routinely provides the 20 months standard MDR-TB regimen recommended by the WHO. In addition to this routine therapy, Viet Nam is also beginning a pilot to treat 100 MDR-TB patients with a nine-month regimen from 1st September 2015 onwards.
"Globally treatment success rate for MDR-TB is around 48% whereas Viet Nam is among five countries in the world to achieve treatment success rate of 70%. Our major challenge is to deal with the 20% or so patients where the treatment is not successful and mortality may be high – may be they have extensively drug resistant TB (XDR-TB) or have MDR-TB but intolerance to current regimen becomes an issue, or might be they are pre-XDR with either resistance to quinolone or one of the injectables," said Dr Nhung.
Viet Nam provides individualized regimen for those patients with drug resistant TB based upon their drug susceptibility test (DST) results. Viet Nam is also using a new drug, Bedaquiline for one of its regimen.
Viet Nam had introduced molecular tests for TB such as Gene Xpert almost four years ago. This year 60 more Gene Xpert machines with cartridges will be introduced nationwide with support from UNITAID and Global Fund to fight AIDS, TB and Malaria (The Global Fund). "It is good for Viet Nam that we are keeping Gene Xpert roll-out to public sector where we can regulate its use."
"Last year we had enrolled 1503 MDR-TB patients and this year we aim to enroll 2,200 patients –so scale up is quite fast in Viet Nam. Apart from funding, high commitment from human resource – the people who lead the TB programme on the frontlines – is also extremely important. High commitment from the government is also very critical" emphasized Dr Nhung.
Last year Viet Nam had developed a National TB Strategy for 2020 and vision for 2030 which demonstrates increasing political commitment for accelerating progress towards ending TB.
"Viet Nam is also one of the countries to apply scientific approach to diagnosing TB in children. It is based upon three factors: 1) history of contact within one year, 2) abnormality in chest x-ray consistent with TB, 3) clinical symptom consistent with TB. This approach has increased number of TB diagnosis. Majority of TB in children is primary TB which may otherwise get ignored in the routine clinical setting. Nevertheless it is important to recognize diagnosing TB in children is a challenge. We try to overcome this challenge to some extent by training healthcare providers in how to take x-ray in children and adults to screen them for TB – and then further investigations as required. Also we train healthcare providers and have developed materials in how to read the x-ray and reports. National Conference on Lung Health in Viet Nam which ended a week ago, had a training course on chest x-ray reading, and most delegates wanted to attend it. So people are interested in doing better with existing tools too."
"Commitment from the leader is very important. Today’s best can always be made better tomorrow! We need guidelines and other materials in easy to understand language and style. Counselling is a very important component of TB care and control. TB drugs may be toxic or have side effects so ongoing counselling and social support is very instrumental in ensuring early management of side effects or other related issues as well as ensuring adherence and completion of treatment. For example if a patient knows in advance of side effects then they don’t get surprised by side effects and less likely to leave treatment midway. Patient support programme is so important" said Dr Nhung.
In Viet Nam, people with TB get their transportation expenses covered in addition to all other diagnostic and treatment services for TB being free too. "We also try to encourage nurses and doctors to be friendly and empathise with patients. Interaction between doctors and patients is very important. Patients too can play a key role by sharing their experience with others and help other people walk through the treatment successfully" said Dr Nhung.
Bobby Ramakant, Citizen News Service - CNS
31 August 2015
(The author is providing thematic coverage from the 5th Asia Pacific Region Conference on Lung Health, of the International Union Against Tuberculosis and Lung Disease (The Union). He is supported by the Lilly MDR TB Partnership. Follow him on Twitter: @CNS_Health and @bobbyramakant)