ACT3: Impact assessment of community-wide screening for TB using Xpert MTB/RIF to reduce the prevelence of TB in Ca Mau province, Vietnam
Woolcock screening staff in Vietnam have already screened 12,000 people for tuberculosis, a disease that continues to take lives despite the availability of effective treatment. Community-wide screening in the southernmost province of Vietnam began in March this year. Funds permitting, the project will continue for another three and a half years.
Systematic community-wide screening for tuberculosis has not taken place since the mid-20th Century. Thanks to an NHMRC grant, Woolcock staff are trialling a novel community-wide screening method using a new test called Xpert MTB/RIF which reduces the time taken to detect tuberculosis, including drug-resistant tuberculosis, from two weeks to two hours. If this new diagnostic strategy proves cost-effective and efficient, it will serve as a model that will inform public policy in countries with a high-burden of tuberculosis. With the high burden of TB throughout Southeast Asia, the problem is best understood as regional. Australia’s efforts to lower TB incidence abroad helps lower TB incidence at home.
The Woolcock Institute has been conducting tuberculosis research in Vietnam for a number of years thanks to the efforts of Professor Guy Marks, Dr Greg Fox, local collaborators, and a strong team of Woolcock researchers based in Hanoi and Ca Mau. The tuberculosis screening program in Ca Mau is our biggest undertaking yet. The plan is to screen people for tuberculosis in 120 villages by the end of the four-year project. Participants who are diagnosed with tuberculosis are referred to the National Tuberculosis Program for free treatment. More than just a research study, this project is helping reduce the burden of tuberculosis and lower rates of disease transmission.
Tuberculosis screening in the Mekong Delta is not easy. Fieldstaff have to travel by motorbike, by boat, and sometimes by foot to reach villages that have been randomly selected to participate in the screening research trial. In addition to the screening equipment, information flyers, and personal protection equipment, fieldstaff often have to bring their own food provisions as well. Screening is conducted door-to-door and fieldstaff use a state-of-the-art digital automated system for collecting data on a handheld tablet. Screening each person is timely and it can take up to a week in any given village. The difficulties of the fieldstaff to reach and work in some of these locations are a potent reminder of the challenges locals face in seeking medical treatment. The Woolcock reimburses screening participants who are diagnosed with tuberculosis or multidrug resistant tuberculosis for their travel costs to Ca Mau city to commence tuberculosis treatment. Through this research study, the Woolcock has now helped forty patients commence treatment through the National Tuberculosis Program. We look forward to reporting on the ongoing success of this program as the project progresses.
By Paul H. Mason
Paul is a medical anthropologist who is working alongside the TB screening program in Ca Mau. He has received funding from the Tuberculosis Centre for Research Excellence to undertake qualitative research to complement the screening program.