A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City, Viet Nam
Abstract Background To achieve the WHO End TB Strategy targets, it is necessary to detect and treat more people with active TB early. Scale–up of active case finding (ACF) may be one strategy to achieve that goal. Given human resource constraints in the health systems of most high TB burden countrie...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-020-09042-4 |
| _version_ | 1831836598375809024 |
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| author | Luan Nguyen Quang Vo Rachel Jeanette Forse Andrew James Codlin Thanh Nguyen Vu Giang Truong Le Giang Chau Do Vinh Van Truong Ha Minh Dang Lan Huu Nguyen Hoa Binh Nguyen Nhung Viet Nguyen Jens Levy Bertie Squire Knut Lonnroth Maxine Caws |
| author_facet | Luan Nguyen Quang Vo Rachel Jeanette Forse Andrew James Codlin Thanh Nguyen Vu Giang Truong Le Giang Chau Do Vinh Van Truong Ha Minh Dang Lan Huu Nguyen Hoa Binh Nguyen Nhung Viet Nguyen Jens Levy Bertie Squire Knut Lonnroth Maxine Caws |
| author_sort | Luan Nguyen Quang Vo |
| collection | DOAJ |
| description | Abstract Background To achieve the WHO End TB Strategy targets, it is necessary to detect and treat more people with active TB early. Scale–up of active case finding (ACF) may be one strategy to achieve that goal. Given human resource constraints in the health systems of most high TB burden countries, volunteer community health workers (CHW) have been widely used to economically scale up TB ACF. However, more evidence is needed on the most cost-effective compensation models for these CHWs and their potential impact on case finding to inform optimal scale-up policies. Methods We conducted a two-year, controlled intervention study in 12 districts of Ho Chi Minh City, Viet Nam. We engaged CHWs as salaried employees (3 districts) or incentivized volunteers (3 districts) to conduct ACF among contacts of people with TB and urban priority groups. Eligible persons were asked to attend health services for radiographic screening and rapid molecular diagnosis or smear microscopy. Individuals diagnosed with TB were linked to appropriate care. Six districts providing routine NTP care served as control area. We evaluated additional cases notified and conducted comparative interrupted time series (ITS) analyses to assess the impact of ACF by human resource model on TB case notifications. Results We verbally screened 321,020 persons in the community, of whom 70,439 were eligible for testing and 1138 of them started TB treatment. ACF activities resulted in a + 15.9% [95% CI: + 15.0%, + 16.7%] rise in All Forms TB notifications in the intervention areas compared to control areas. The ITS analyses detected significant positive post-intervention trend differences in All Forms TB notification rates between the intervention and control areas (p = 0.001), as well as between the employee and volunteer human resource models (p = 0.021). Conclusions Both salaried and volunteer CHW human resource models demonstrated additionality in case notifications compared to routine case finding by the government TB program. The salaried employee CHW model achieved a greater impact on notifications and should be prioritized for scale-up, given sufficient resources. |
| first_indexed | 2024-12-23T05:00:15Z |
| format | Article |
| id | doaj.art-7786c5b2003c497cb5e63783a4149942 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-23T05:00:15Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-7786c5b2003c497cb5e63783a41499422022-12-21T17:59:15ZengBMCBMC Public Health1471-24582020-06-0120111210.1186/s12889-020-09042-4A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City, Viet NamLuan Nguyen Quang Vo0Rachel Jeanette Forse1Andrew James Codlin2Thanh Nguyen Vu3Giang Truong Le4Giang Chau Do5Vinh Van Truong6Ha Minh Dang7Lan Huu Nguyen8Hoa Binh Nguyen9Nhung Viet Nguyen10Jens Levy11Bertie Squire12Knut Lonnroth13Maxine Caws14Friends for International TB ReliefFriends for International TB ReliefFriends for International TB ReliefHo Chi Minh City Public Health AssociationHo Chi Minh City Public Health AssociationPham Ngoc Thach HospitalPham Ngoc Thach HospitalPham Ngoc Thach HospitalPham Ngoc Thach HospitalNational Lung HospitalNational Lung HospitalKNCV TuberculosefondsLiverpool School of Tropical Medicine, Department of Clinical SciencesKarolinska Institutet, Department of Global Public HealthLiverpool School of Tropical Medicine, Department of Clinical SciencesAbstract Background To achieve the WHO End TB Strategy targets, it is necessary to detect and treat more people with active TB early. Scale–up of active case finding (ACF) may be one strategy to achieve that goal. Given human resource constraints in the health systems of most high TB burden countries, volunteer community health workers (CHW) have been widely used to economically scale up TB ACF. However, more evidence is needed on the most cost-effective compensation models for these CHWs and their potential impact on case finding to inform optimal scale-up policies. Methods We conducted a two-year, controlled intervention study in 12 districts of Ho Chi Minh City, Viet Nam. We engaged CHWs as salaried employees (3 districts) or incentivized volunteers (3 districts) to conduct ACF among contacts of people with TB and urban priority groups. Eligible persons were asked to attend health services for radiographic screening and rapid molecular diagnosis or smear microscopy. Individuals diagnosed with TB were linked to appropriate care. Six districts providing routine NTP care served as control area. We evaluated additional cases notified and conducted comparative interrupted time series (ITS) analyses to assess the impact of ACF by human resource model on TB case notifications. Results We verbally screened 321,020 persons in the community, of whom 70,439 were eligible for testing and 1138 of them started TB treatment. ACF activities resulted in a + 15.9% [95% CI: + 15.0%, + 16.7%] rise in All Forms TB notifications in the intervention areas compared to control areas. The ITS analyses detected significant positive post-intervention trend differences in All Forms TB notification rates between the intervention and control areas (p = 0.001), as well as between the employee and volunteer human resource models (p = 0.021). Conclusions Both salaried and volunteer CHW human resource models demonstrated additionality in case notifications compared to routine case finding by the government TB program. The salaried employee CHW model achieved a greater impact on notifications and should be prioritized for scale-up, given sufficient resources.http://link.springer.com/article/10.1186/s12889-020-09042-4Comparative impact evaluationHuman resource modelEmployeesVolunteersCommunity health workersTuberculosis |
| spellingShingle | Luan Nguyen Quang Vo Rachel Jeanette Forse Andrew James Codlin Thanh Nguyen Vu Giang Truong Le Giang Chau Do Vinh Van Truong Ha Minh Dang Lan Huu Nguyen Hoa Binh Nguyen Nhung Viet Nguyen Jens Levy Bertie Squire Knut Lonnroth Maxine Caws A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City, Viet Nam BMC Public Health Comparative impact evaluation Human resource model Employees Volunteers Community health workers Tuberculosis |
| title | A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City, Viet Nam |
| title_full | A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City, Viet Nam |
| title_fullStr | A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City, Viet Nam |
| title_full_unstemmed | A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City, Viet Nam |
| title_short | A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City, Viet Nam |
| title_sort | comparative impact evaluation of two human resource models for community based active tuberculosis case finding in ho chi minh city viet nam |
| topic | Comparative impact evaluation Human resource model Employees Volunteers Community health workers Tuberculosis |
| url | http://link.springer.com/article/10.1186/s12889-020-09042-4 |
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