An Effective Health System Approach to End TB: Implementing the Double X Strategy in Vietnam

Countries that are high burden for TB must reverse the COVID-19 pandemic's devastating effects to accelerate progress toward ending TB. Vietnam's Double X (2X) strategy uses chest radiography (CXR) and GeneXpert (Xpert) rapid diagnostic testing to improve early detection of TB disease. Hou...

Full description

Saved in:

Bibliographic Details
Published in:	Global health science and practice Vol. 12; no. 3; p. e2400024
Main Authors:	Innes, Anh L, Lebrun, Victoria, Hoang, Gia Linh, Martinez, Andres, Dinh, Nhi, Nguyen, Thi Thuy Ha, Huynh, Tan Phat, Quach, Van Luong, Nguyen, Thanh Binh, Trieu, Van Chinh, Tran, Nghi Do Bao, Pham, Huy Minh, Dinh, Van Luong, Nguyen, Binh Hoa, Truong, Thi Thanh Huyen, Nguyen, Van Cu, Nguyen, Viet Nhung, Mai, Thu Hien
Format:	Journal Article
Language:	English
Published:	United States Global Health: Science and Practice 27-06-2024
Subjects:	COVID-19 - epidemiology COVID-19 - prevention & control Female Field Action Report Humans Male Mass Screening - methods Mass Screening - organization & administration Middle Aged Pandemics Radiography, Thoracic SARS-CoV-2 Tuberculosis - diagnosis Tuberculosis - epidemiology Tuberculosis - prevention & control Tuberculosis, Pulmonary - diagnosis Tuberculosis, Pulmonary - epidemiology Tuberculosis, Pulmonary - prevention & control Vietnam - epidemiology Vulnerable Populations Vietnam
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Countries that are high burden for TB must reverse the COVID-19 pandemic's devastating effects to accelerate progress toward ending TB. Vietnam's Double X (2X) strategy uses chest radiography (CXR) and GeneXpert (Xpert) rapid diagnostic testing to improve early detection of TB disease. Household contacts and vulnerable populations (e.g., individuals aged 60 years and older, smokers, diabetics, those with alcohol use disorders, and those previously treated for TB) with and without TB symptoms were screened in community campaigns using CXRs, followed by Xpert for those with a positive screen. In public non-TB district facilities, diabetics, respiratory outpatients, inpatients with lung disease, and other vulnerable populations underwent 2X evaluation. During COVID-19 restrictions in Vietnam, the 2X strategy improved access to TB services by decentralization to commune health stations, the lowest level of the health system, and enabling self-screening using a quick response mobile application. The number needed to screen (NNS) with CXRs to diagnose 1 person with TB disease was calculated for all 2X models and showed the highest yield among self-screeners (11 NNS with CXR), high yield for vulnerable populations in communities (60 NNS) and facilities (19 NNS), and moderately high yield for household contacts in community campaigns (154 NNS). Computer-aided diagnosis for CXRs was incorporated into community and facility implementation and improved physicians' CXR interpretations and Xpert referral decisions. Integration of TB infection and TB disease evaluation increased eligibility for TB preventive treatment among household contacts, a major challenge during implementation. The 2X strategy increased the rational use of Xpert, employing a health system-wide approach that reached vulnerable populations with and without TB symptoms in communities and facilities for early detection of TB disease. This strategy was effectively adapted to different levels of the health system during COVID-19 restrictions and contributed to post-pandemic TB recovery in Vietnam.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2169-575X 2169-575X
DOI:	10.9745/GHSP-D-24-00024