1. Country Progress Report VIET NAM
The ninth Technical Advisory Group and National TB Programme Managers meeting for TB control in the Western Pacific Region
Manila, Philippines
9 -12 December 2014

2. TB Epidemiology

3. Estimated TB trends during 1990-2013 in Viet Nam
Prevalence: Reduce 4.6% every year
Incidence: Reduce 2.6%
Mortality: Reduce 4.4% every year

4. Major successes
The National Strategy for TB control (by 2020 with vision to 2030) has been approved by the Government, and disseminated to all localities and TB control facilities nationwide.
Successful in the Joint Concept Note TB/HIV submitted to GF with the total budget was $ 42 M for
Performance of activities under the GF during 2013 was rated at A1 and 6 first month 2014 was rated A2. Success in the targets of PMDT; TB/HIV; TB in children; PPM; PAL; TB in prisons; case-finding and treatment.
Implementation of DOTS strategy: covered 100% of communes and population. Maintain high cure rate (~ 90% for new smear positive) and maintain high quality with LQAS (proportion of major error (0.14%) and minor error (0.83%).
Health information system (VITIMES and e-TB Manager): maintain and expanded to district level, plan for fully upgrade and expansion nationwide in 2015.
The TB control network is expanded and reinforced. With VSTP, strengthen collaboration with partners: Ministry of Public Security; MoLISA; VAAC; PATH; TB REACH; WHO; CDC, …central and provincial general hospitals.

5. Major challenges
TB in Vietnam remains high (Both for the TB and MDR-TB)
PMDT: unable to detect all TB suspects, clinical case management and MDR-TB patients management in community remain challenging. Treatment of TB patients outside the NTP with low successful rate, high default rate, which causes the increase of TB, especially M/XDR-TB.
Funding for ACSM works is limited due to state budget constraint and new mechanism of GFATM .
TB control work in closed settings remain challenging: lack of quality workers; lack of TB diagnostic and therapeutic equipments,.... while TB, MDR-TB, HIV infection rate in prisons is very high.
PPM activities remain limited. Almost collaborative activities are on referral of TB suspects. Recording activities are not yet done in private facilities.
Collaboration in detection of childhood TB between the NTP and pediatric facilities has not yet become routine and effective. Still lack of qualified health workers.

6. NATIONAL STRATEGY ON TUBECULOSIS CONTROL TO 2020 WITH VISION TO 2030
- Objectives by 2015:
+ Reduce prevalence rate in community to less than 187/100,000 pop;
+ Reduce TB mortality rate to less than 18/100,000 pop;
+ Reduce MDR-TB rate to less than 5% among new TB cases.
- Objectives by 2020:
+ Reduce prevalence rate in community to less than 131/100,000 pop;
+ Reduce TB mortality rate to less than 10/100,000 pop;
+ Maintain MDR-TB rate at less than 5% of total new TB cases.
- Vision by 2030
Continue to reduce TB mortality rate and prevalence rate in community to less than 20/100,000 pop, moving forward to the aim of Vietnamese people living in a TB free environment.

7. NATIONAL STRATEGY ON TUBECULOSIS CONTROL TO 2020 WITH VISION TO 2030
The National Strategy on TB Control align with WHO End TB strategy
The National Strategy on TB Control align with National Health Sector Plan
Budgeted: Estimated ~ $ 663 M for 6 years
Funding sources:
State budget as per annual budget law,
Health Insurance fund,
Funding from grants: Global Fund, CDC, USAIDS, WHO, TB Challenge, Woolcock
Funding from local and international organizations and individuals
Other legal funding sources

8. Laboratory strengthening Existing lab test for TB diagnosis
Focus on
Smear: ZN, FM (Fluorescent Microscopy)
Xpert: 46
LPA: Hain (FL, SL)
Culture: Solid (Ogawa, LJ), liquid (BACTEC MGIT, MGIT)
DST: Solid, liquid

9. Laboratory quality assurance system
TA partners: from Adeline & WHO

10. Reach the unreached Intensive case finding:
Entry screening and periodic screening for early detection in prisoners
Implement active case finding in the provinces with low case-finding.
TB screening policy and practice:
Using CXR and Sputum smear examination for TB suspects (cough for more than two weeks)
Contact screening.
Active case finding for high risk groups
TB-HIV:
Collaborations between 2 programmes / Screening TB among HIV patients and testing for HIV among TB patients
Child-TB:
INH prevention
Screening for household contact
Intensified case finding with new algorithm for diagnosis of TB in children

11. Surveillance Quality of surveillance system:
Based on WHO-recommended paper-based system with quarterly reporting of cases
Transitioning to case-based electronic recording and reporting
Data entry at district level
Full national coverage planned for 2015
Good internal and external consistency
New case definition: Planned to roll out in 2015
e-R&R: VITIMES and e-TB Manager
Data is analysed and used at national and sub-national levels for reporting, planning, advocacy, evaluate the performance of the activities

12. PMDT: Implementation process
Register with Green Light Committee (GLC): 12/5/2007; Approved by GLC: 29/6/2007; Pilot in HCM city: 101 patients (9/2009)
Expand in 6 provinces (2010) 20 provinces (2011, 12)  35 provinces (2013)  41 provinces (2014, 2015)
The accumulative number of enrolled patients until 9/2014 : 3509 MDR-TB patients
Year
2009
2010
2011
Treatment centre 1 6 10
Satellite provinces 14 25 31
Total 20 35 41
Number of culture sample
Total
< 100
<500
>500
Culture Lab 3 10 11 24
GeneXpert Lab 33
DST Lab 2

13. PMDT: Target & Implementation results
2009
2010
2011
2012
2013
2014
(9 months)
Total
The number of enrolled patients
101 97
578
713
948
1072
3094
% of enrollment compared to total estimated number 3%
16%
19%
25%
27%
Target
2015
2016
2017
2018
2019
2020
Enrolment
2,200
2,500
2,900
3,000
2,800
PMDT Provinces 41 50 57 63
Successful rate of MDR TB cohort in 2011: 73%

14. PMDT in Vietnam: Difficulties
Not yet 100% coverage of PMDT
There is not yet new regimen for MDR-TB patients who have failed treatment, XDR-TB patients
Second line drug procurement: long lead time
TB drug in free market: not yet controlled
Funding for PMDT is totally based on external funding (TB CARE & GF round 9): insufficient, sustainability ?
Infection control: weak practice in community
Palliative care: has not implemented yet
Psychological – economic – social support is still limited

15. PMDT in Vietnam: Solutions
Strengthen basic DOTS for MDR TB prevention
Increase PMDT coverage
Plan for failed DR-TB, XDR-TB management: New TB drugs (BDQ introduction; Delanamid)
Sustainable funding plan for PMDT, especially SLDs supply (local budget, health insurance)
Control the distribution of TB drugs in free market and strengthen public-private mix DOT
Improve infection control, especially in community
Develop plan for palliative care for DR-TB patients
Strengthen psychological-economic-social support for DR-TB patients during their treatment

16. Bold policies and supportive systems
Involved the whole political system in TB control through the National Strategy
Establish TB Control Steering committee at all provinces
Develop a ACSM agenda to support policy changes, relevant law development
Advocate for new mechanism of health insurance to contribute in TB services
Update TB control guidelines and widely disseminate to all trained health care workers
Strengthen Viet Nam Stop TB partnership for engagement of all national and international stakeholders, including technical agencies, donors and corporate sector.
Strengthen capacity of the program at all level in term of Coordination, Supervision and Management

17. Patient centred care: involvement of patients and civil society
National strategy for TB control: TB control is mainly community-based and implemented by the whole TB and Lung diseases control network from central to local in collaboration with public and non-public health facilities and effective community participation
Encourage sub commune health workers to be involved in TB education, detection and follow up treatment
PMDT: Supporter 2 is trained commune worker (family member, social worker, …), transportation support, social, psychological consultation.
Farmer Union has TB Control Club: people can help to screen, refer and support each other financially and labour supports
Ongoing establishment of TB patient network to deal with stigma and experience sharing of successful story of TB treatment especially MDR TB treatment
Advocate for a TB treatment package cost of health insurance which included patient home visit and support.