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Title: An analysis of multi drug resistant tuberculosis control in Vietnam
Author: Hoang, Thi Thanh Thuy
Awarding Body: Open University
Current Institution: Open University
Date of Award: 2016
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Multi-drug resistant tuberculosis is a major global health problem. Viet Nam is 14th among 27 MDR-TB high burden countries with an estimated about 5,100 MDR-TB cases among notified TB cases per year. Management of MDR-TB in Viet Nam is one of the main objectives of the TB control programme. This thesis provides an understanding of the current situation of MDRlXDR-TB in Vietnam and its control policies focusing on case finding strategy, targeting groups for MDR-TB screening. MDR-TB contacts, one of the high risk groups recommended by the WHO is a focus of this thesis. The thesis presents screening practices of household contacts of TB patients, feasibility of TB contact investigations, and to identify challenges and solutions for a successful implementation of an efficient contact investigation among MDR -TB patients in Viet Nam. Since 2009, the programmatic management of drug resistant tuberculosis (PMDT) was piloted in Viet Nam following the development of 2009 country MDR TB guideline. A year after the WHO updated guideline was disseminated, the country revised its guideline and SOP to be in line with WHO's recommendations and contextualized to local capacity and resources. The PMDT has been rolled out and scaled up in the country. However, lack of resources, limited communication on policy changes to lower level, unable to provide screening to all risk groups, inadequate capacity to perform diagnosis of mono and poly resistant TB and second- line DST have posed significant challenges for the NTP to implement their policy. This study found that only about 30 % MDR TB cases was detected. through the PMDT system. The possible reasons we identified were: (1) delay in fully rolling out PMDT policies and limited capacity of the system, mostly due to inadequate resources, (2) operational factors, . . and (3) neglecting high risk groups during MDR- TB screening, particularly close contacts of MDR TB patients. Noteworthy, the NTP strategy relies on "passive case finding" while the proportion of household contacts of smear-positive tuberculosis patients screened for TB under the current passive screening approach of the Vietnam National TB program is very low compared with prevalence of TB among contacts in high burden countries, particularly for contacts under 5 years of age. Although screening of close contacts of MDR-TB patients is recommended by the NTP of Viet Nam, this is generally not done.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available