Progress towards universal HIV testing among TB patients in Viet Nam:a retrospective cohort evaluation of TB/HIV surveillance,2011-2017

Background:Tuberculosis(TB)and HIV remain a major causes of morbidity and mortality globally.We conducted an analysis of TB/HIV surveillance data to describe the trends in HIV testing coverage and HIV positivity rate among TB patients in Viet Nam,2011-2017.Main text:This was a descriptive study based on review and analysis of surveillance data from the National Tuberculosis Control Programme from 2011 to 2017.During this period,721342 TB cases were diagnosed.Of these,520490(72.2%)had a previously documented HIV status or were tested for HIV during TB care and treatment.The proportion of TB patients whose HIV status was reported increased,from 58.5%in 2011 to 82.9%in 2017(P value for trend=0.014).The proportion of TB patients infected with HIV decreased,from 8.0%in 2011 to 3.7%in 2017(P value for trend=0.018).Conclusions:The proportion of TB patients with a reported HIV status was increased from 2011 to 2017,however HIV testing coverage remained below the National Tuberculosis Control Programme targets(>90%).National Tuberculosis Control Programme needs to focus on ensuring eveny registered TB patients has a documented HIV status,ensuring full coverage of HIV testing as part of routine TB care.

The contribution of a non-governmental organisation’s Community Based Tuberculosis Care Programme to case finding in Myanmar:trend over time

Background:It is estimated that the standard,passive case finding(PCF)strategy for detecting cases of tuberculosis(TB)in Myanmar has not been successful:26%of cases are missing.Therefore,alternative strategies,such as active case finding(ACF)by community volunteers,have been initiated since 2011.This study aimed to assess the contribution of a Community Based TB Care Programme(CBTC)by local non-government organizations(NGOs)to TB case finding in Myanmar over 4 years.Methods:This was a descriptive study using routine,monitoring data.Original data from the NGOs were sent to a central registry within the National TB Programme and data for this study were extracted from that database.Data from all 84 project townships in five regions and three states in Myanmar were used.The project was launched in 2011.Results:Over time,the number of presumptive TB cases that were referred decreased,except in the Yangon Region,although in some areas,the numbers fluctuated.At the same time,there was a trend for the proportion of cases treated,compared to those referred,that decreased over time(P=0.051).Overall,among 84 townships,the contribution of CBTC to total case detection deceased from 6%to 4%over time(P<0.001).Conclusions:Contrary to expectations and evidence from previous studies in other countries,a concerning reduction in TB case finding by local NGO volunteer networks in several areas in Myanmar was recorded over 4 years.This suggests that measures to support the volunteer network and improve its performance are needed.They may include discussion with local NGOs human resources personnel,incentives for the volunteers,closer supervision of volunteers and improved monitoring and evaluation tools.

Active case-finding for tuberculosis by mobile teams in Myanmar:yield and treatment outcomes

Background:Since 2005,the Myanmar National Tuberculosis Programme(NTP)has been implementing active case finding(ACF)activities involving mobile teams in hard-to-reach areas.This study revealed the contribution of mobile team activities to total tuberculosis(TB)case detection,characteristics of TB patients detected by mobile teams and their treatment outcomes.Methods:This was a descriptive study using routine programme data between October 2014 and December 2014.Mobile team activities were a one-stop service and included portable digital chest radiography(CXR)and microscopy of two sputum samples.The algorithm of the case detection included screening patients by symptoms,then by CXR followed by sputum microscopy for confirmation.Diagnosed patients were started on treatment and followed until a final outcome was ascertained.Results:A total of 9349 people with symptoms suggestive of TB were screened by CXR,with an uptake of 96.6%.Of those who were meant to undergo sputum smear microscopy,51.4%had sputum examinations.Finally,504 TB patients were identified by the mobile teams and the overall contribution to total TB case detection in the respective townships was 25.3%.Among total cases examined by microscopy,6.4%were sputum smear positive TB.Treatment success rate was high as 91.8%in study townships compared to national rate 85%(2014 cohort).Conclusions:This study confirmed the feasibility and acceptability of ACF by mobile teams in hard-to-reach contexts,especially when equipped with portable,digital CXR machines that provided immediate results.However,the follow-up process of sputum examination created a significant barrier to confirmation of the diagnosis.In order to optimize the ACF through mobile team activity,future ACF activities were needed to be strengthened one stop service including molecular diagnostics or provision of sputum cups to all presumptive TB cases prior to CXR and testing if CXR suggestive of TB.