Tuberculosis in Vietnam

A study aimed to assess the effectiveness and feasibility of the Double X (2X) strategy for improving tuberculosis (TB) detection and treatment in Vietnam, both in community and healthcare facility settings. The 2X strategy involves using chest X-ray (CXR) triage followed by Xpert testing for TB diagnosis. By investigating its performance across various implementation sites, the research sought to determine how well this strategy works under real-world conditions, and whether it can be scaled and sustained within Vietnam’s broader TB control framework.

To explore this, researchers conducted a programmatic implementation and evaluation study. They employed a descriptive analysis of routine health data collected from 2020 to 2022 across nine Vietnamese provinces with differing TB prevalence levels. The study design included both retrospective data reviews and prospective data collection via monthly reporting systems. This mixed-method approach made it particularly suitable for evaluating public health interventions in operational settings, allowing a detailed look into outcomes, implementation barriers, and cost-effectiveness metrics of the 2X strategy.

The study tracked multiple variables. Independent variables included the implementation of the 2X strategy, the type of population screened (such as household contacts and vulnerable groups), and demographic factors like age and sex. The dependent variables measured outcomes such as the number of TB cases detected, the initiation rate of TB preventive treatment (TPT), and the positivity rate of TB infection tests. Potential confounding factors like regional differences in TB prevalence and disparities in access to diagnostic infrastructure were also considered. Technical indicators such as CXR and Xpert test coverage, number needed to screen (NNS), and program costs were used to further interpret findings.

Results showed significant successes. From 2020 to 2022, the study screened over 21,000 household contacts and 79,000 TB-vulnerable individuals in the community, yielding 140 and 1,255 TB cases respectively. In health facility settings, over half a million people were evaluated, with the highest TB detection among older adults, smokers, and those with alcohol use disorders. Infection testing indicated a 15.7% positivity rate, and over 63% of eligible individuals began TPT. Importantly, the project demonstrated higher TB detection in men and older populations. From a cost perspective, although it varied by model, the strategy was generally efficient, and the government incorporated it into national guidelines in October 2020, with project provinces seeing a faster uptake of Xpert testing than control areas.

In conclusion, the implementation of the 2X strategy proved highly effective in detecting TB and integrating disease and infection diagnosis into routine practice. Its strong performance across diverse settings, combined with favorable cost efficiency and policy adoption, suggests that the 2X approach is both a feasible and impactful method for TB control in Vietnam. These findings support continued expansion and long-term integration of the strategy within national health systems.

Source: Innes, A.L., Lebrun, V., Hoang, G.L., Martinez, A., Dinh, N., Nguyen, T.T.H., Huynh, T.P., Quach, V.L., Nguyen, T.B., Trieu, V.C. and Tran, N.D.B., 2024. An effective health system approach to end TB: implementing the double X strategy in Vietnam. Global Health: Science and Practice, 12(3).