Total - WHO Western Pacific Region

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Country Progress Report
VIET NAM
The ninth Technical Advisory Group and National TB
Programme Managers meeting for TB control in the
Western Pacific Region
Manila, Philippines
9 -12 December 2014
TB Epidemiology
Estimated TB trends during
1990-2013 in Viet Nam
Prevalence: Reduce 4.6% every year
¯
Incidence: Reduce 2.6%
Lao PDR
TB notification rate
(per 100000)
<50
50 - 99
100-149
150-199
>200
Cambodia
Mortality: Reduce 4.4% every year
Major successes
1.
2.
3.
4.
5.
6.
The National Strategy for TB control (by 2020 with vision to 2030) has been
approved by the Government, and disseminated to all localities and TB
control facilities nationwide.
Successful in the Joint Concept Note TB/HIV submitted to GF with the total
budget was $ 42 M for 2015-2017 .
Performance of activities under the GF during 2013 was rated at A1 and 6
first month 2014 was rated A2. Success in the targets of PMDT; TB/HIV; TB in
children; PPM; PAL; TB in prisons; case-finding and treatment.
Implementation of DOTS strategy: covered 100% of communes and
population. Maintain high cure rate (~ 90% for new smear positive) and
maintain high quality with LQAS (proportion of major error (0.14%) and
minor error (0.83%).
Health information system (VITIMES and e-TB Manager): maintain and
expanded to district level, plan for fully upgrade and expansion nationwide
in 2015.
The TB control network is expanded and reinforced. With VSTP, strengthen
collaboration with partners: Ministry of Public Security; MoLISA; VAAC;
PATH; TB REACH; WHO; CDC, …central and provincial general hospitals.
Major challenges
1.
TB in Vietnam remains high (Both for the TB and MDR-TB)
2.
PMDT: unable to detect all TB suspects, clinical case management and MDRTB patients management in community remain challenging. Treatment of TB
patients outside the NTP with low successful rate, high default rate, which
causes the increase of TB, especially M/XDR-TB.
3.
Funding for ACSM works is limited due to state budget constraint and new
mechanism of GFATM .
4.
TB control work in closed settings remain challenging: lack of quality workers;
lack of TB diagnostic and therapeutic equipments,.... while TB, MDR-TB, HIV
infection rate in prisons is very high.
5.
PPM activities remain limited. Almost collaborative activities are on referral of
TB suspects. Recording activities are not yet done in private facilities.
6.
Collaboration in detection of childhood TB between the NTP and pediatric
facilities has not yet become routine and effective. Still lack of qualified health
workers.
NATIONAL STRATEGY ON TUBECULOSIS CONTROL
TO 2020 WITH VISION TO 2030
- Objectives by 2015:
+ Reduce prevalence rate in community to less than 187/100,000 pop;
+ Reduce TB mortality rate to less than 18/100,000 pop;
+ Reduce MDR-TB rate to less than 5% among new TB cases.
- Objectives by 2020:
+ Reduce prevalence rate in community to less than 131/100,000 pop;
+ Reduce TB mortality rate to less than 10/100,000 pop;
+ Maintain MDR-TB rate at less than 5% of total new TB cases.
- Vision by 2030
Continue to reduce TB mortality rate and prevalence rate in community to
less than 20/100,000 pop, moving forward to the aim of Vietnamese
people living in a TB free environment.
NATIONAL STRATEGY ON TUBECULOSIS CONTROL
TO 2020 WITH VISION TO 2030
• The National Strategy on TB Control align with WHO End TB
strategy
• The National Strategy on TB Control align with National Health
Sector Plan
• Budgeted: Estimated ~ $ 663 M for 6 years 2015-2020
• Funding sources:
•
•
•
•
•
State budget as per annual budget law,
Health Insurance fund,
Funding from grants: Global Fund, CDC, USAIDS, WHO, TB
Challenge, Woolcock
Funding from local and international organizations and individuals
Other legal funding sources
Laboratory strengthening
Existing lab test for TB diagnosis
Focus on





Smear: ZN, FM (Fluorescent Microscopy)
Xpert: 46
LPA: Hain (FL, SL)
Culture: Solid (Ogawa, LJ), liquid (BACTEC MGIT, MGIT)
DST: Solid, liquid
Laboratory quality assurance system
• TA partners: from Adeline & WHO
Reach the unreached
• Intensive case finding:
– Entry screening and periodic screening for early detection in prisoners
– Implement active case finding in the provinces with low case-finding.
• TB screening policy and practice:
– Using CXR and Sputum smear examination for TB suspects (cough for
more than two weeks)
– Contact screening.
– Active case finding for high risk groups
• TB-HIV:
– Collaborations between 2 programmes / Screening TB among HIV
patients and testing for HIV among TB patients
• Child-TB:
– INH prevention
– Screening for household contact
– Intensified case finding with new algorithm for diagnosis of TB in children
Surveillance
• Quality of surveillance system:
– Based on WHO-recommended paper-based system with
quarterly reporting of cases
– Transitioning to case-based electronic recording and reporting
• Data entry at district level
• Full national coverage planned for 2015
– Good internal and external consistency
• New case definition: Planned to roll out in 2015
• e-R&R: VITIMES and e-TB Manager
• Data is analysed and used at national and sub-national levels for
reporting, planning, advocacy, evaluate the performance of the
activities
PMDT: Implementation process
• Register with Green Light Committee (GLC): 12/5/2007; Approved by
GLC: 29/6/2007; Pilot in HCM city: 101 patients (9/2009)
• Expand in 6 provinces (2010) 20 provinces (2011, 12)  35
provinces (2013)  41 provinces (2014, 2015)
• The accumulative number of enrolled patients until 9/2014 : 3509
MDR-TB patients
Year
Treatment centre
2009
2010
1
6
Satellite provinces
Total
1
6
2011
2012-2013
2014-2015
6
10
10
14
25
31
20
35
41
Number of culture sample
< 100
Culture Lab
<500
3
Total
>500
10
11
24
GeneXpert Lab
33
DST Lab
2
PMDT: Target &
Implementation results
Implementation
2009
2010
2011
2012
2013
2014
(9 months)
The number of
enrolled patients
101
97
578
713
948
1072
% of enrollment
compared to total
estimated number
3%
3%
16%
19%
25%
27%
Total
3094
Target
2015
2016
2017
2018
2019
2020
Enrolment
PMDT
Provinces
2,200
2,500
2,900
3,000
2,900
2,800
41
50
57
63
63
63
Successful rate of MDR TB cohort in 2011: 73%
PMDT in Vietnam: Difficulties
•
•
•
•
•
•
•
•
Not yet 100% coverage of PMDT
There is not yet new regimen for MDR-TB patients who
have failed treatment, XDR-TB patients
Second line drug procurement: long lead time
TB drug in free market: not yet controlled
Funding for PMDT is totally based on external funding
(TB CARE & GF round 9): insufficient, sustainability ?
Infection control: weak practice in community
Palliative care: has not implemented yet
Psychological – economic – social support is still limited
PMDT in Vietnam: Solutions
•
•
•
•
•
•
•
•
Strengthen basic DOTS for MDR TB prevention
Increase PMDT coverage
Plan for failed DR-TB, XDR-TB management: New TB drugs
(BDQ introduction; Delanamid)
Sustainable funding plan for PMDT, especially SLDs supply
(local budget, health insurance)
Control the distribution of TB drugs in free market and
strengthen public-private mix DOT
Improve infection control, especially in community
Develop plan for palliative care for DR-TB patients
Strengthen psychological-economic-social support for DR-TB
patients during their treatment
Bold policies and supportive systems
1. Involved the whole political system in TB control through the
National Strategy
2. Establish TB Control Steering committee at all provinces
3. Develop a ACSM agenda to support policy changes, relevant law
development
4. Advocate for new mechanism of health insurance to contribute in
TB services
5. Update TB control guidelines and widely disseminate to all trained
health care workers
6. Strengthen Viet Nam Stop TB partnership for engagement of all
national and international stakeholders, including technical
agencies, donors and corporate sector.
7. Strengthen capacity of the program at all level in term of
Coordination, Supervision and Management
Patient centred care: involvement
of patients and civil society
National strategy for TB control: TB control is mainly community-based and
implemented by the whole TB and Lung diseases control network from
central to local in collaboration with public and non-public health facilities
and effective community participation
1.Encourage sub commune health workers to be involved in TB education,
detection and follow up treatment
2.PMDT: Supporter 2 is trained commune worker (family member, social
worker, …), transportation support, social, psychological consultation.
3.Farmer Union has TB Control Club: people can help to screen, refer and
support each other financially and labour supports
4.Ongoing establishment of TB patient network to deal with stigma and
experience sharing of successful story of TB treatment especially MDR TB
treatment
5.Advocate for a TB treatment package cost of health insurance which
included patient home visit and support.
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