An Innovative Public-Private Mix Model for Improving Tuberculosis Care in Vietnam: How Well are We Doing?

To improve tuberculosis (TB) care among individuals attending a private tertiary care hospital in Vietnam, an innovative private sector engagement model was implemented from June to December 2018. This included: (i) Active facility-based screening of all adults for TB symptoms (and chest x-ray (CXR) for those with symptoms) by trained and incentivized providers, with on-site diagnostic testing or transport of sputum samples, (ii) a mobile application to reduce dropout in the care cascade and (iii) enhanced follow-up care by community health workers. We conducted a cohort study using project and routine surveillance data for evaluation. Among 52,078 attendees, 368 (0.7%) had symptoms suggestive of TB and abnormalities on CXR. Among them, 299 (81%) were tested and 103 (34.4%) were diagnosed with TB. In addition, 195 individuals with normal CXR were indicated for TB testing by attending clinicians, of whom, seven were diagnosed with TB. Of the 110 TB patients diagnosed, 104 (95%) were initiated on treatment and 97 (93%) had a successful treatment outcome. Given the success of this model, the National TB Programme is considering to scale it up nationwide after undertaking a detailed cost-effectiveness analysis.

Digital health for the End TB Strategy: developing priority products and making them work.

In 2014, the World Health Organization (WHO) developed the End TB Strategy in response to a World Health Assembly Resolution requesting Member States to end the worldwide epidemic of tuberculosis (TB) by 2035. For the strategy's objectives to be realised, the next 20 years will need novel solutions to address the challenges posed by TB to health professionals, and to affected people and communities. Information and communication technology presents opportunities for innovative approaches to support TB efforts in patient care, surveillance, programme management and electronic learning. The effective application of digital health products at a large scale and their continued development need the engagement of TB patients and their caregivers, innovators, funders, policy-makers, advocacy groups, and affected communities.In April 2015, WHO established its Global Task Force on Digital Health for TB to advocate and support the development of digital health innovations in global efforts to improve TB care and prevention. We outline the group's approach to stewarding this process in alignment with the three pillars of the End TB Strategy. The supplementary material of this article includes target product profiles, as developed by early 2016, defining nine priority digital health concepts and products that are strategically positioned to enhance TB action at the country level.

Chronic diseases among the elderly in a rural Vietnam: prevalence, associated socio-demographic factors and healthcare expenditures.

BACKGROUND: Globally, the population of elderly persons is increasing as well as the prevalence of chronic diseases. This change is causing increased healthcare costs to health care systems threatening to push many households into poverty. Low and middle income countries are projected to experience the greatest impact from this change. This study aims to describe the prevalence of common chronic diseases (CCDs) among the elderly in Vietnam, the associated socio-demographic factors and healthcare expenditures. METHODS: This is a cross-sectional study in the FilaBavi demographic surveillance site in Vietnam. 2873 persons over 60 years were randomly sampled. Prevalence of CCDs was reported from study subjects who previously were informed by physicians. Healthcare expenditures were determined from recall of expenses during the last hospital visit. Binomial logistic regression was done to determine the socio demographic predictors of having a CCD or multiple CCDs. Mean healthcare expenditures for the elderly with CCDs and those without CCDs were summarised and compared. RESULTS: Forty two percent of the elderly were found to have at least one CCD. Joint problems were the most common CCD at 35 %, followed by hypertension at 15 % and chronic bronchitis at 11 %. Being female (OR = 1.51, 95 % CI = 1.03-2.21, p-value = 0.036), higher education (OR = 2.54, 95 % CI = 1.13-5.74, p-value = 0.025) and having advanced age (OR = 1.92, 95 % CI = 1.22-3.00, p-value = 0.005), were associated with common chronic diseases in the elderly. Outpatient healthcare expenditures were found to be significantly higher for the elderly with CCDs than those without CCDs. CONCLUSIONS: Higher education and being female are important key predictors of having a CCD, while wealth quintile is a predictor of multimorbidity, in the elderly. Healthcare expenditures for outpatient health services are higher for elderly persons with CCDs and these costs should be targeted when planning for financial protection.

Willingness to use and pay for options of care for community-dwelling older people in rural Vietnam.

BACKGROUND: The proportion of people in Vietnam who are 60 years and over has increased rapidly. The emigration of young people and impact of other socioeconomic changes leave more elderly on their own and with less family support. This study assesses the willingness to use and pay for different models of care for community-dwelling elderly in rural Vietnam. METHODS: In 2007, people aged 60 and older and their family representatives, living in 2,240 households, were randomly selected from the FilaBavi Demographic Surveillance Site. They were interviewed using structured questionnaires to assess dependence in activities of daily living (ADLs), willingness to use and to pay for day care centres, mobile care teams, and nursing centres. Respondent socioeconomic characteristics were extracted from the FilaBavi repeated census. Percentages of those willing to use models and the average amount (with 95% confidence intervals) they are willing to pay were estimated. Multivariate analyses were performed to measure the relationship of willingness to use services with ADL index and socioeconomic factors. Four focus group discussions were conducted to explore people's perspectives on the use of services. The first discussion group was with the elderly. The second discussion group was with their household members. Two other discussion groups included community association representatives, one at the communal level and another at the village level. RESULTS: Use of mobile team care is the most requested service. The fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than do the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require that services be free-of-charge is two to three times higher than the proportion willing to pay full cost. Households are willing to pay more than the elderly for day care and nursing centres. The elderly are more willing to pay for mobile teams than are their households. Age group, sex, literacy, marital status, living arrangement, living area, working status, poverty, household wealth and dependence in ADLs are factors related to willingness to use services. CONCLUSIONS: Community-centric elderly care will be used and partly paid for by individuals if it is provided by the government or associations. Capacity building for health professional networks and informal caregivers is essential for developing formal care models. Additional support is needed for the most vulnerable elderly to access services.