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Dinh LV, Vo LNQ, Wiemers AMC, Nguyen HB, Vu HQ, Mo HTL, Nguyen LP, Nguyen NTT, Dong TTT, Tran KT, Dang TMH, Nguyen LH, Pham AT, Codlin AJ, Forse RJ. Ensuring Continuity of Tuberculosis Care during Social Distancing through Integrated Active Case Finding at COVID-19 Vaccination Events in Vietnam: A Cohort Study. Trop Med Infect Dis 2024; 9:26. [PMID: 38276637 PMCID: PMC10819868 DOI: 10.3390/tropicalmed9010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
COVID-19 significantly disrupted tuberculosis (TB) services in Vietnam. In response, the National TB Program (NTP) integrated TB screening using mobile chest X-rays into COVID-19 vaccination events. This prospective cohort study evaluated the integrated model's yield, treatment outcomes, and costs. We further fitted regressions to identify risk factors and conduct interrupted time-series analyses in the study area, Vietnam's eight economic regions, and at the national level. At 115 events, we conducted 48,758 X-ray screens and detected 174 individuals with TB. We linked 89.7% to care, while 92.9% successfully completed treatment. The mean costs per person diagnosed with TB was $547. TB risk factors included male sex (aOR = 6.44, p < 0.001), age of 45-59 years (aOR = 1.81, p = 0.006) and ≥60 years (aOR = 1.99, p = 0.002), a history of TB (aOR = 7.96, p < 0.001), prior exposure to TB (aOR = 3.90, p = 0.001), and symptomatic presentation (aOR = 2.75, p < 0.001). There was a significant decline in TB notifications during the Delta wave and significant increases immediately after lockdowns were lifted (IRR(γ1) = 5.00; 95%CI: (2.86, 8.73); p < 0.001) with a continuous upward trend thereafter (IRR(γ2) = 1.39; 95%CI: (1.22, 1.38); p < 0.001). Similar patterns were observed at the national level and in all regions but the northeast region. The NTP's swift actions and policy decisions ensured continuity of care and led to the rapid recovery of TB notifications, which may serve as blueprint for future pandemics.
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Affiliation(s)
- Luong Van Dinh
- National Lung Hospital, Ha Noi 100000, Vietnam; (L.V.D.); (H.B.N.); (H.Q.V.)
| | - Luan Nguyen Quang Vo
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
- Department of Global Health, WHO Collaboration Centre on Tuberculosis and Social Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Anja Maria Christine Wiemers
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
| | - Hoa Binh Nguyen
- National Lung Hospital, Ha Noi 100000, Vietnam; (L.V.D.); (H.B.N.); (H.Q.V.)
| | - Hoa Quynh Vu
- National Lung Hospital, Ha Noi 100000, Vietnam; (L.V.D.); (H.B.N.); (H.Q.V.)
| | - Huong Thi Lan Mo
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
| | - Lan Phuong Nguyen
- IRD VN Social Enterprise Company Limited, Ho Chi Minh City 700000, Vietnam;
| | - Nga Thi Thuy Nguyen
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
| | - Thuy Thi Thu Dong
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
| | - Khoa Tu Tran
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
| | - Thi Minh Ha Dang
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700000, Vietnam; (T.M.H.D.); (L.H.N.)
| | - Lan Huu Nguyen
- Pham Ngoc Thach Hospital, Ho Chi Minh City 700000, Vietnam; (T.M.H.D.); (L.H.N.)
| | | | - Andrew James Codlin
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
- Department of Global Health, WHO Collaboration Centre on Tuberculosis and Social Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Rachel Jeanette Forse
- Friends for International Tuberculosis Relief (FIT), Ha Noi 100000, Vietnam; (A.M.C.W.); (H.T.L.M.); (N.T.T.N.); (T.T.T.D.); (K.T.T.); (A.J.C.); (R.J.F.)
- Department of Global Health, WHO Collaboration Centre on Tuberculosis and Social Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
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Vo LNQ, Codlin A, Ngo TD, Dao TP, Dong TTT, Mo HTL, Forse R, Nguyen TT, Cung CV, Nguyen HB, Nguyen NV, Nguyen VV, Tran NT, Nguyen GH, Qin ZZ, Creswell J. Early Evaluation of an Ultra-Portable X-ray System for Tuberculosis Active Case Finding. Trop Med Infect Dis 2021; 6:163. [PMID: 34564547 PMCID: PMC8482270 DOI: 10.3390/tropicalmed6030163] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 12/20/2022] Open
Abstract
X-ray screening is an important tool in tuberculosis (TB) prevention and care, but access has historically been restricted by its immobile nature. As recent advancements have improved the portability of modern X-ray systems, this study represents an early evaluation of the safety, image quality and yield of using an ultra-portable X-ray system for active case finding (ACF). We reported operational and radiological performance characteristics and compared image quality between the ultra-portable and two reference systems. Image quality was rated by three human readers and by an artificial intelligence (AI) software. We deployed the ultra-portable X-ray alongside the reference system for community-based ACF and described TB care cascades for each system. The ultra-portable system operated within advertised specifications and radiologic tolerances, except on X-ray capture capacity, which was 58% lower than the reported maximum of 100 exposures per charge. The mean image quality rating from radiologists for the ultra-portable system was significantly lower than the reference (3.71 vs. 3.99, p < 0.001). However, we detected no significant differences in TB abnormality scores using the AI software (p = 0.571), nor in any of the steps along the TB care cascade during our ACF campaign. Despite some shortcomings, ultra-portable X-ray systems have significant potential to improve case detection and equitable access to high-quality TB care.
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Affiliation(s)
- Luan Nguyen Quang Vo
- Friends for International TB Relief, Ha Noi 100000, Vietnam; (A.C.); (T.T.T.D.); (R.F.)
| | - Andrew Codlin
- Friends for International TB Relief, Ha Noi 100000, Vietnam; (A.C.); (T.T.T.D.); (R.F.)
| | - Thuc Doan Ngo
- IRD VN, Ho Chi Minh City 700000, Vietnam; (T.D.N.); (T.P.D.); (H.T.L.M.); (N.T.T.); (G.H.N.)
| | - Thang Phuoc Dao
- IRD VN, Ho Chi Minh City 700000, Vietnam; (T.D.N.); (T.P.D.); (H.T.L.M.); (N.T.T.); (G.H.N.)
| | - Thuy Thi Thu Dong
- Friends for International TB Relief, Ha Noi 100000, Vietnam; (A.C.); (T.T.T.D.); (R.F.)
| | - Huong Thi Lan Mo
- IRD VN, Ho Chi Minh City 700000, Vietnam; (T.D.N.); (T.P.D.); (H.T.L.M.); (N.T.T.); (G.H.N.)
| | - Rachel Forse
- Friends for International TB Relief, Ha Noi 100000, Vietnam; (A.C.); (T.T.T.D.); (R.F.)
| | | | - Cong Van Cung
- National Lung Hospital, Ha Noi 100000, Vietnam; (C.V.C.); (H.B.N.); (N.V.N.)
| | - Hoa Binh Nguyen
- National Lung Hospital, Ha Noi 100000, Vietnam; (C.V.C.); (H.B.N.); (N.V.N.)
| | - Nhung Viet Nguyen
- National Lung Hospital, Ha Noi 100000, Vietnam; (C.V.C.); (H.B.N.); (N.V.N.)
| | | | - Ngan Thi Tran
- IRD VN, Ho Chi Minh City 700000, Vietnam; (T.D.N.); (T.P.D.); (H.T.L.M.); (N.T.T.); (G.H.N.)
| | - Giang Hoai Nguyen
- IRD VN, Ho Chi Minh City 700000, Vietnam; (T.D.N.); (T.P.D.); (H.T.L.M.); (N.T.T.); (G.H.N.)
| | - Zhi Zhen Qin
- Stop TB Partnership, 1218 Geneva, Switzerland; (Z.Z.Q.); (J.C.)
| | - Jacob Creswell
- Stop TB Partnership, 1218 Geneva, Switzerland; (Z.Z.Q.); (J.C.)
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