RT Journal Article
SR Electronic
T1 An Effective Health System Approach to End TB: Implementing the Double X Strategy in Vietnam
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2400024
DO 10.9745/GHSP-D-24-00024
VO 12
IS 3
A1 Innes, Anh L.
A1 Lebrun, Victoria
A1 Hoang, Gia Linh
A1 Martinez, Andres
A1 Dinh, Nhi
A1 Nguyen, Thi Thuy Ha
A1 Huynh, Tan Phat
A1 Quach, Van Luong
A1 Nguyen, Thanh Binh
A1 Trieu, Van Chinh
A1 Tran, Nghi Do Bao
A1 Pham, Huy Minh
A1 Dinh, Van Luong
A1 Nguyen, Binh Hoa
A1 Truong, Thi Thanh Huyen
A1 Nguyen, Van Cu
A1 Nguyen, Viet Nhung
A1 Mai, Thu Hien
YR 2024
UL http://www.ghspjournal.org/content/12/3/e2400024.abstract
AB Key FindingsVietnam’s Double X (2X) strategy—using chest radiography and GeneXpert rapid diagnostic testing to improve early detection of TB disease—detected TB disease with high yield, effectively reaching TB-vulnerable populations with and without symptoms in communities and facilities.The 2X strategy was effectively adapted during the COVID-19 pandemic restrictions by decentralizing expertise for identifying vulnerable populations at the community level and mainstreaming TB services to non-TB district-level facilities.Interventions to address implementation challenges included computer-aided diagnosis to interpret chest radiographs, which improved the quality of referral for diagnostic testing. Integration of TB infection with TB disease evaluation increased household contacts’ eligibility for TB preventive treatment, a major challenge during implementation.Key ImplicationsProgram managers should consider using 2X to operationalize universal access to a World Health Organization-recommended rapid diagnostic as the first test for individuals with presumed TB.Implementers should consider evaluating vulnerable populations across the TB spectrum—from infection to asymptomatic and symptomatic TB disease—using the 2X framework to prevent, diagnose, and cure TB.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.