HIV infection among tuberculosis patients in Vietnam: prevalence and impact on tuberculosis notification rates.

BACKGROUND: Vietnam has an emerging human immunodeficiency virus (HIV) epidemic (estimated population prevalence 0.5%), but valid data on HIV prevalence among tuberculosis (TB) patients are limited. Recent increases in TB notification rates among young adults may be related to HIV. OBJECTIVES: To assess the prevalence of HIV infection among smear-positive TB patients in six provinces with relatively high HIV population prevalence in Vietnam. METHODS: All patients who registered for treatment of smear-positive TB during the fourth quarter of 2005 were offered HIV testing. RESULTS: Of the 1217 TB patients included in the study, 100 (8.2%) tested HIV-positive. HIV prevalence varied between 2% and 17% in the provinces, and was strongly associated with age < 35 years, injecting drug use, commercial sex work and a history of sexually transmitted disease. Among men aged 15-34 years, the rate of notification of new smear-positive TB that was attributable to HIV infection varied from 3-4 per 100,000 population in mainly rural provinces to 20-42/100,000 in provinces with rapid industrial and commercial development. CONCLUSION: Among TB patients in Vietnam, HIV infection is concentrated in drug users, as well as in specific geographic areas where it has considerable impact on TB notification rates among men aged 15-34 years.

Excess mortality and tuberculosis among individuals with prolonged cough: a population-based study from Vietnam.

SETTING: A demographic surveillance site in north-west Vietnam. OBJECTIVES: To compare notification rates of sputum smear-positive tuberculosis (TB) and mortality rates between the general population and individuals with prolonged cough. DESIGN: A cohort study of 559 prolonged cough cases in a total population of 35,832, observed over 2.5 years. Outcome measures were sputum smear-positive TB and death. RESULTS: The age-standardised smear-positive TB notification rate among cough cases (553/100,000 person-years [py], 95%CI 268-1143) was significantly higher than in the general population (50/100,000 py, 95%CI 43-57), with a relative risk of 11.06 (95%CI 8.28-14.77). Among those who had a chest X-ray suggestive of TB but negative sputum smears prior to the study start, the rate was 6542/100,000 py (95%CI 2906-12,511). The cough cohort had a 2.61 (95%CI 2.38-2.87) times higher risk of dying than the general population. CONCLUSIONS: Individuals with prolonged cough in this study run a significantly increased risk of developing infectious TB and of dying. We recommend further evaluations of improved follow-up systems aimed at identifying and treating sputum smear-negative TB cases before they convert to an infectious stage.

Do women with tuberculosis have a lower likelihood of getting diagnosed? Prevalence and case detection of sputum smear positive pulmonary TB, a population-based study from Vietnam.

OBJECTIVE: The aim was to estimate the gender-specific prevalence of tuberculosis (TB) through screening. A further aim was to calculate case detection within the Vietnamese National TB program. STUDY DESIGN AND SETTING: A population-based survey of 35,832 adults was performed within an existing sociodemographic longitudinal study in Bavi district, northern Vietnam. Cases were identified by a screening question about prolonged cough and further diagnosed with sputum examination and a chest X-ray. RESULTS: The estimated prevalence of pulmonary TB among men was 90/100,000 (95% CI 45-135/100,000) and among women 110/100,000 (95% CI 63-157/100,000). Case detection in the district was estimated to 39% (95% CI 20-76%) among men and 12% (95% CI 6-26%) among women. CONCLUSION: TB prevalence was similar among men and women. Case detection among men and women was significantly lower than the reported national case detection of 80%, and there was a significant underdetection of female cases. These findings warrant actions, and emphasize the need to perform similar studies in different contexts.

An economic analysis of persons with prolonged cough in rural northern Vietnam.

SETTING: Epidemiological surveillance in the Bavi district, northern Vietnam. OBJECTIVE: To compare the prevalences of prolonged cough across socio-economic groups defined by income, expenditure and official classification. To investigate inequalities using the Illness Concentration Index. DESIGN: Interviews in 11,547 randomly selected households with 35,832 persons aged 15 years or more. Prolonged cough was identified in 559 persons (1.5%). RESULTS: Differences between cough prevalences were found for all socio-economic indicators, but were less clear for expenditure. Lower economic groups reported higher prevalences than higher groups, and prevalences were higher among the elderly. Male was similar to female prevalence. The illness gap between the poor and rich was wider for men. The Illness Concentration Index confirmed these findings. CONCLUSION: Inequalities were found when using both different socio-economic indicators and different analysis approaches.

Knowledge about tuberculosis and its treatment among new pulmonary TB patients in the north and central regions of Vietnam.

SETTING: Tuberculosis (TB) units in 42 districts in north and central Vietnam were included in the study. OBJECTIVES: To describe patients' knowledge of TB and to evaluate the impact of the National Tuberculosis Programme's health education. DESIGN: New pulmonary TB patients who had received TB treatment for a minimum of 1 month were interviewed using a structured questionnaire. RESULTS: A total of 364 patients were interviewed; 93% of respondents reported receiving TB information from the health staff. Apart from health education, many patients reported TB information from the TV. This was more common among men than women (71.4% vs. 51.3%). The average knowledge score was 7.07 +/- 2.02 (maxium 10). This was significantly associated with level of education and receiving health education. More than half of the patients expressed fear of being known as TB patients in the community. CONCLUSIONS: Knowledge about TB and its treatment was generally high. Marginalised groups with limited access to media and low education levels may benefit from specially targeted educational interventions. To reduce stigma and the impact of social consequences of TB, an ongoing health education programme designed to increase the knowledge level in the whole population appears warranted.

Health-seeking behaviour of individuals with a cough of more than 3 weeks.

Sex inequalities can lead to poorer access to health care and delays to diagnosis of tuberculosis in women. In a population-based survey we assessed health-seeking behaviour in adults with long-term cough. The prevalence of cough was 1% (213) and 2% (279) in men and women, respectively. Women took more health-care actions than men, but chose less qualified providers and reported lower health expenditure per visit. Delay before seeking hospital treatment was longer for women (41 days) than men (19 days; p=0.04), and more men (27; 36%) than women (14; 14%; p=0.0006) reported giving a sputum sample at hospital. Sex-sensitive strategies for tuberculosis control are needed and should take into account sex differences in health-care seeking behaviour as well as a possible sex bias among health-care providers.