Optimising diagnosis and treatment of tuberculosis infection in community and primary care settings in two urban provinces of Viet Nam: a cohort study
Objectives To end tuberculosis (TB), the vast reservoir of 1.7–2.3 billion TB infections (TBIs) must be addressed, but achieving global TB preventive therapy (TPT) targets seems unlikely. This study assessed the feasibility of using interferon-γ release assays (IGRAs) at lower healthcare levels and...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/2/e071537.full |
| _version_ | 1811167613596729344 |
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| author | Maxine Caws Viet Nhung Nguyen Rachel Forse Jacob Creswell Luan Nguyen Quang Vo Nga Thi Thuy Nguyen Thuy Thi Thu Dong Andrew Codlin Huyen Thanh Truong Hoa Binh Nguyen Ha Thi Minh Dang Vinh Van Truong Lan Huu Nguyen Tuan Huy Mac Phong Thanh Le Khoa Tu Tran Nduku Ndunda |
| author_facet | Maxine Caws Viet Nhung Nguyen Rachel Forse Jacob Creswell Luan Nguyen Quang Vo Nga Thi Thuy Nguyen Thuy Thi Thu Dong Andrew Codlin Huyen Thanh Truong Hoa Binh Nguyen Ha Thi Minh Dang Vinh Van Truong Lan Huu Nguyen Tuan Huy Mac Phong Thanh Le Khoa Tu Tran Nduku Ndunda |
| author_sort | Maxine Caws |
| collection | DOAJ |
| description | Objectives To end tuberculosis (TB), the vast reservoir of 1.7–2.3 billion TB infections (TBIs) must be addressed, but achieving global TB preventive therapy (TPT) targets seems unlikely. This study assessed the feasibility of using interferon-γ release assays (IGRAs) at lower healthcare levels and the comparative performance of 3-month and 9-month daily TPT regimens (3HR/9H).Design, setting, participants and intervention This cohort study was implemented in two provinces of Viet Nam from May 2019 to September 2020. Participants included household contacts (HHCs), vulnerable community members and healthcare workers (HCWs) recruited at community-based TB screening events or HHC investigations at primary care centres, who were followed up throughout TPT.Primary and secondary outcomes We constructed TBI care cascades describing indeterminate and positivity rates to assess feasibility, and initiation and completion rates to assess performance. We fitted mixed-effects logistic and stratified Cox models to identify factors associated with IGRA positivity and loss to follow-up (LTFU).Results Among 5837 participants, the indeterminate rate was 0.8%, and 30.7% were IGRA positive. TPT initiation and completion rates were 63.3% (3HR=61.2% vs 9H=63.6%; p=0.147) and 80.6% (3HR=85.7% vs 9H=80.0%; p=0.522), respectively. Being male (adjusted OR=1.51; 95% CI: 1.28 to 1.78; p<0.001), aged 45–59 years (1.30; 1.05 to 1.60; p=0.018) and exhibiting TB-related abnormalities on X-ray (2.23; 1.38 to 3.61; p=0.001) were associated with positive IGRA results. Risk of IGRA positivity was lower in periurban districts (0.55; 0.36 to 0.85; p=0.007), aged <15 years (0.18; 0.13 to 0.26; p<0.001), aged 15–29 years (0.56; 0.42 to 0.75; p<0.001) and HCWs (0.34; 0.24 to 0.48; p<0.001). The 3HR regimen (adjusted HR=3.83; 1.49 to 9.84; p=0.005) and HCWs (1.38; 1.25 to 1.53; p<0.001) showed higher hazards of LTFU.Conclusion Providing IGRAs at lower healthcare levels is feasible and along with shorter regimens may expand access and uptake towards meeting TPT targets, but scale-up may require complementary advocacy and education for beneficiaries and providers. |
| first_indexed | 2024-04-10T16:12:07Z |
| format | Article |
| id | doaj.art-f479e6b13bc6426d9e48bbe9134768ef |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-10T16:12:07Z |
| publishDate | 2023-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-f479e6b13bc6426d9e48bbe9134768ef2023-02-09T23:00:09ZengBMJ Publishing GroupBMJ Open2044-60552023-02-0113210.1136/bmjopen-2022-071537Optimising diagnosis and treatment of tuberculosis infection in community and primary care settings in two urban provinces of Viet Nam: a cohort studyMaxine Caws0Viet Nhung Nguyen1Rachel Forse2Jacob Creswell3Luan Nguyen Quang Vo4Nga Thi Thuy Nguyen5Thuy Thi Thu Dong6Andrew Codlin7Huyen Thanh Truong8Hoa Binh Nguyen9Ha Thi Minh Dang10Vinh Van Truong11Lan Huu Nguyen12Tuan Huy Mac13Phong Thanh Le14Khoa Tu Tran15Nduku Ndunda16Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal7 The National Lung Hospital, Hanoi, VietnamDepartment of Global Public Health, Karolinska Institutet, Stockholm, SwedenStop TB Partnership, Geneva, Switzerland1 Friends for International TB Relief, Ha Noi, Viet Nam1 Friends for International TB Relief, Ha Noi, Viet Nam1 Friends for International TB Relief, Ha Noi, Viet Nam1 Friends for International TB Relief, Ha Noi, Viet Nam5 National Lung Hospital, Ha Noi, Viet Nam5 National Lung Hospital, Ha Noi, Viet Nam6 Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam6 Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam6 Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam7 Hai Phong Lung Hospital, Hai Phong, Viet Nam8 IRD VN Social Enterprise, Ho Chi Minh City, Viet Nam1 Friends for International TB Relief, Ha Noi, Viet Nam9 Consultant, Dubai, UAEObjectives To end tuberculosis (TB), the vast reservoir of 1.7–2.3 billion TB infections (TBIs) must be addressed, but achieving global TB preventive therapy (TPT) targets seems unlikely. This study assessed the feasibility of using interferon-γ release assays (IGRAs) at lower healthcare levels and the comparative performance of 3-month and 9-month daily TPT regimens (3HR/9H).Design, setting, participants and intervention This cohort study was implemented in two provinces of Viet Nam from May 2019 to September 2020. Participants included household contacts (HHCs), vulnerable community members and healthcare workers (HCWs) recruited at community-based TB screening events or HHC investigations at primary care centres, who were followed up throughout TPT.Primary and secondary outcomes We constructed TBI care cascades describing indeterminate and positivity rates to assess feasibility, and initiation and completion rates to assess performance. We fitted mixed-effects logistic and stratified Cox models to identify factors associated with IGRA positivity and loss to follow-up (LTFU).Results Among 5837 participants, the indeterminate rate was 0.8%, and 30.7% were IGRA positive. TPT initiation and completion rates were 63.3% (3HR=61.2% vs 9H=63.6%; p=0.147) and 80.6% (3HR=85.7% vs 9H=80.0%; p=0.522), respectively. Being male (adjusted OR=1.51; 95% CI: 1.28 to 1.78; p<0.001), aged 45–59 years (1.30; 1.05 to 1.60; p=0.018) and exhibiting TB-related abnormalities on X-ray (2.23; 1.38 to 3.61; p=0.001) were associated with positive IGRA results. Risk of IGRA positivity was lower in periurban districts (0.55; 0.36 to 0.85; p=0.007), aged <15 years (0.18; 0.13 to 0.26; p<0.001), aged 15–29 years (0.56; 0.42 to 0.75; p<0.001) and HCWs (0.34; 0.24 to 0.48; p<0.001). The 3HR regimen (adjusted HR=3.83; 1.49 to 9.84; p=0.005) and HCWs (1.38; 1.25 to 1.53; p<0.001) showed higher hazards of LTFU.Conclusion Providing IGRAs at lower healthcare levels is feasible and along with shorter regimens may expand access and uptake towards meeting TPT targets, but scale-up may require complementary advocacy and education for beneficiaries and providers.https://bmjopen.bmj.com/content/13/2/e071537.full |
| spellingShingle | Maxine Caws Viet Nhung Nguyen Rachel Forse Jacob Creswell Luan Nguyen Quang Vo Nga Thi Thuy Nguyen Thuy Thi Thu Dong Andrew Codlin Huyen Thanh Truong Hoa Binh Nguyen Ha Thi Minh Dang Vinh Van Truong Lan Huu Nguyen Tuan Huy Mac Phong Thanh Le Khoa Tu Tran Nduku Ndunda Optimising diagnosis and treatment of tuberculosis infection in community and primary care settings in two urban provinces of Viet Nam: a cohort study BMJ Open |
| title | Optimising diagnosis and treatment of tuberculosis infection in community and primary care settings in two urban provinces of Viet Nam: a cohort study |
| title_full | Optimising diagnosis and treatment of tuberculosis infection in community and primary care settings in two urban provinces of Viet Nam: a cohort study |
| title_fullStr | Optimising diagnosis and treatment of tuberculosis infection in community and primary care settings in two urban provinces of Viet Nam: a cohort study |
| title_full_unstemmed | Optimising diagnosis and treatment of tuberculosis infection in community and primary care settings in two urban provinces of Viet Nam: a cohort study |
| title_short | Optimising diagnosis and treatment of tuberculosis infection in community and primary care settings in two urban provinces of Viet Nam: a cohort study |
| title_sort | optimising diagnosis and treatment of tuberculosis infection in community and primary care settings in two urban provinces of viet nam a cohort study |
| url | https://bmjopen.bmj.com/content/13/2/e071537.full |
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