An Innovative Public-Private Mix Model for Improving Tuberculosis Care in Vietnam: How Well are We Doing?

Abstract

To improve tuberculosis (TB) care among individuals attending a private tertiary care hospital in Vietnam, an innovative private sector engagement model was implemented from June to December 2018. This included: (i) Active facility-based screening of all adults for TB symptoms (and chest x-ray (CXR) for those with symptoms) by trained and incentivized providers, with on-site diagnostic testing or transport of sputum samples, (ii) a mobile application to reduce dropout in the care cascade and (iii) enhanced follow-up care by community health workers. We conducted a cohort study using project and routine surveillance data for evaluation. Among 52,078 attendees, 368 (0.7%) had symptoms suggestive of TB and abnormalities on CXR. Among them, 299 (81%) were tested and 103 (34.4%) were diagnosed with TB. In addition, 195 individuals with normal CXR were indicated for TB testing by attending clinicians, of whom, seven were diagnosed with TB. Of the 110 TB patients diagnosed, 104 (95%) were initiated on treatment and 97 (93%) had a successful treatment outcome. Given the success of this model, the National TB Programme is considering to scale it up nationwide after undertaking a detailed cost-effectiveness analysis.

Keywords: SORT IT; missing cases; operational research; public–private mix model; public–private partnership.

Figure 1

Cascade of tuberculosis care (from screening to treatment outcome) among the patients attending the Haiphong International General Hospital in Vietnam, from June to December 2018. OPD = Outpatient Department; TB = tuberculosis; TRC = transcription concerted reaction. a: successful outcome: cured and treatment completed. B: unsuccessful outcome: death, loss to follow-up, failure, and not evaluated. *Two individuals had rifampicin resistance and were started on second-line drugs.