VIETNAM END TB PROGRESS

CNS WEBINAR 25th July 2017

A/Prof Nguyn Vit Nhung, MD. PhD

Director, National Lung Hospital
NTP Manager
President, Viet Nam Association Against TB and LD
Contents
Progress towards ending TB in Vietnam, in the past 2-3 years
Are TB rates declining fast enough in Viet Nam to end TB by
2030 ?
What can we do to accelerate the rate of TB decline so as to
meet the targets ?
New approach: PAM Practical Approach to Medicine
 TB epidemiology in Viet Nam
3

Viet Nam ranked 15 / 30 HBC with TB patient burden

(incidence ~ 130,000 cases/year)
Ranked 15/30 HBC with MDR TB patient burden (~ 6000
MDR TB cases/year)
First prevalence survey 2006-2007: Prevalence of TB AFB (+)
was 145/100.000 population
 TB notification and treatment outcome
4

Lao PDR

TB notification rate
(per 100000)
<50
50 - 99
100-149
150-199
>200

Cambodia
 Drug resistant TB management
Structure and availability of services for treatment MDR-TB treatment outcome
Year 200 201 201 2012 2014 2016 2017 Cohort Success Lost to
9 0 1 - - rate follow up
2013 2015
2009 73% 9%
Treatment 1 6 6 10 10 10 10
centre 2010 78% 6%
Satellite 14 25 31 51 53 2011 72% 13%
provinces 2012 71% 12%
Total 1 6 20 35 41 51 63
2013 69% 14%
2014 75% 9%
Achievement: Treatment success rate is higher than the global average rate
Challenges: LTFU rate is increasing when expansion and scale up
Implementation 2011 2012 2013 2014 2015 2016 2017

The number of patients with DST result 7879 21246 29629 50221 16218(*)

The number of patients diagnosed as DR-TB 697 774 997 1790 2558 2.644 861
The number of enrolled patients 578 713 948 1532 2131 2.450 1067(**)
% of enrollment compared to total estimated 16% 19% 19% 30% 42% 47%
5
(*) Data for Q1 2017; (**) Data till 30 May 2017
 Plans for introducing new drugs and
the shorter regimen
Content The number of patients The number of patients The number of
on BDQ treatment on shorter regimen patients on DlM

Pilot cohort 100/99 100/100 100/0

(plan/actual enrolled) (2015-2017) (2016) (2017-2018)
2017 Expansion 50 (Q3-4/2017)* 500 (17)
2018 Expansion : n (%) 100 1650 (50)
2019 Expansion : n (%) 400 2275 (65) To be decided
2020 Expansion : n (%) 500 2960 (80) To be decided

Achievement: Challenges:
Patients on BDQ:
Conversion rate (6 months): 85 % Management of ADR in the community when
Unchanged regimen: 88.6% expansion of new drugs and shorter regimen

Patients on Shorter regimen

Conversion rate (4 months): 85,7%
Unchanged regimen: 94%
 MDG Goal was achieved in 2015
Viet Nam was one among 9 HBCs achieved 3 indicators of TB MDGs
7
NATIONAL STRATEGY FOR TB CONTROL 2015 - 2030

2015 2020 2030

Current
declining rate
is not enough
to meet the
targets !

10% 20%
 Accelerating TB declining rate to meet the targets
Sustainable political commitment
1. Viet Nam Stop TB
Partnership
2. Stricly follow the National
Strategy 2014
3. Policy dialogue along with
APEC meeting August 2017
4. TB Site event conferecen
along with APEC 2018 :
Optimal use of
technologies and
approaches to end TB in
APEC region
5. Preapare for Global
Ministerial Meeting in
Moscow and UNGA High
level meeting on TB 2018
6. Advocacy for strong
community involvement,
Zero TB initiative
Optimal use of all existing tools
1. Detect all TB forms as early as
possible by
- Xray Xpert
- Intensified cases finding in all
vulnerable group (HH
contacts, HIV, Diaabetes )
- PAL, PPM, PAM
2. TB Treatment: Precision
medicine
Nation-wide Standardized
regimens:
Regular TB : 6 month FLDs
MDR TB : 9 mos SLDs
Pre- , XDR TB: BDQ based
regimen
Scale up PMDT
Social protection and patients
support foundation - PASTB
3. Latent TB treatment: need a
test to identified and 3HP
regimen
Research and innovation
1. Strong TB Research body:
Path finding country to end TB:
VICTORY established in 2015
2. Introduction of new tools for
diagnosis, treatment and prevention
ACT3: screening TB in community
VQUIN: Lfx for MDR TB contacts
TBTC-31: Short regimen with
Rifapentine
DNA chip for rapid detection of
drug resistance.
3. Digital Health applications:
VITIMES, E-TB Manager,
m-Health, CAD4TB
4. PAM: Practical Approach to
Medicine (TB, asthma, COPD,
respiratory infection, lung cancer,
hypertension, diabetes, smoking
cessation and pulmonary
rehabilitation)
 THANK YOU FOR YOUR ATTENTION

Reduction of 10%

END TB STRATEGY
Full deployment
of existing
interventions,
technologies,
approaches

VICTORY
Intensified new
interventions,
new tech. ,
Reduction of 20%
approaches

VIET NAM INTEGRATED CENTER FOR TB AND RESPIROLOGY RESEARCH