Characterising the ‘cascade of care’ for multidrug-resistant tuberculosis in endemic settings

Background: Multidrug-resistant tuberculosis is an urgent global public health challenge. Not only do affected patients have a poor prognosis, but they also face considerable social and economic burdens. In spite of the availability of treatment for drug resistant TB, many patients drop out due to toxicity or health system barriers that impede their care.

Vietnam is a resource-limited country in south-east Asia where around 5,000 people each year develop multidrug-resistant tuberculosis. 30% of all patients fail to complete treatment, despite the provision of free treatment through an standardised national program. Strategies to improve treatment outcomes will require a greater understanding of the barriers to care, and an understanding of factors affecting adherence and the continuity of care.

Project details: This project aims to evaluate the ‘cascade of care’ for multidrug-resistant tuberculosis in Vietnam, and develop strategies to enhance retention in care throughout treatment. It will be nested within an NHMRC-funded clinical trial, the VQUIN MDR Trial, which is evaluating the effectiveness of antibiotic therapy to preventmultidrug-resistant TB among contacts of patients with the disease.

The scope of  project(s) undertaken with this study will depend upon the interest and skills of the successful candidate, following consultation with the supervisor. Specific components of this body of work may include the following:

1.    Qualitative work evaluating factors contributing to loss-to-follow-up among patients treated for drug-resistant tuberculosis in Vietnam

2.    Evaluation of epidemiological, clinical and health system factors associated with loss to follow-up and death due to drug-resistant TB, using a ‘cascade of care’ framework.

3.    A multi-centre study evaluating the effectiveness of mobile-phone based adherence support strategies for patients with multidrug-resistant tuberculosis in Vietnam.

4.    Evaluation of factors leading to catastrophic economic loss among households of patients with drug-resistant TB.

Project team: The VQUIN MDR Trial is being implemented in Vietnam by the Woolcock Institute of Medical Research, in partnership with collaborators from the Vietnam National Lung Hospital, and other partners in 10 Provinces across Vietnam. The proposed study will be conducted in a representative number of District clinics throughout the country

Desired capabilities: This project is suitable for students with an interest in epidemiological and public health research in resource-limited settings, with a focus upon translational research and policy development. Knowledge of the health system challenges faced by resource-limited settings is an advantage. Suitable candidates will be cross-culturally competent and motivated by a desire to improve health care in resource-limited settings.

Supervisor: Dr Greg Fox (Australia). In-country support will be provided by the Woolcock Institute of Medical Research in Vietnam.

Timing: Approximately November 2017 – 2020.

Funding: Support within Vietnam will be provided, in the form of a Vietnamese-speaking research assistant according to the requirements of the project. Candidates are encouraged to apply for a scholarship to support their salary. Limited travel support may also be available.