Building a sustainable response to the tuberculosis epidemic

22 Pages·2012·1.61 MB·English

by  Bruce Struminger

Viet Nam STOP-TB
Partnership:
Building a Sustainable Response

1
Nguyen Dinh Huong , Dinh Ngoc Sy2
Nguyen Viet Nhung2, Nguyen Ngoc Minh2
Bruce Struminger3, Cornelia Hennig4
November 15, 2012

Kuala Lumpur, Malaysia
1. Chair of VSTP 3. Former Co-Chair VSTP
2. Vietnam NTP 4. Co Chair VSTP
Vietnam STOP-TB Partnership:
Outline
1. Country background information
2. TB epidemiology
3. Challenges
4. National partnership introduction
5. Partnership principal activities
6. Conclusion
1. Country Background Information
• Area: 330.957 km2
• Distance: >3.200km, borders with
China, Laos & Cambodia
• Population: 89 million (2011)
• Rural: 59,952 million (68,25%)
• Urban: 27,888 million (31,75%)
• Average density: 265/km2
• Administration
• Provinces: 63
• Districts: 698
• Communes: 11,121
• LLMI country since 2010: $1,411
GDP per capita (2011)
2. TB epidemiology in Viet Nam
• Ranks 12th among 22 TB high burden
countries.
• Ranks 14th among 27 countries with
high burden of MDR-TB.
• TB prevalence in Viet Nam remains
high. National prevalence survey
(VINCOTB-06) showed that the
previous estimation was
40% ?
underestimated by 60%.
Too difficult, …
A significant number (~40%) of tuberculosis cases
remain undiagnosed or unreported.
TB epidemiology in Viet Nam 2006
( WHO Report - 2008)
Incidence all cases /100.000 173
Incidence new AFB (+) /100.000 77 114
(Prevalence new AFB (+) -VINCOTB-06)
Prevalence all cases/100,000 225
Prevalence AFB (+) /100.000 90 145
VINCOTB-06
TB mortality /100.000 23
Of new TB cases, % HIV (+) 5.0%
Of new TB cases, % MDR-TB 2.7%
Of previous treated TB, % MDR-TB 19%
TB case notification
Notification trend 2000-10, Viet Nam
Number of suspect screened 2000-09, Viet Nam
800 000 20
s
e
s 600 000
a
c
y
s+ vit
/s 400 000 10siti
s o
ct p
e # suspects %
p
s # ss+ TB cases
u 200 000
s %positivity
#
0
0 1 2 3 4 5 6 7 8 9
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 NTP End term Evaluation 2007-2011.
2 2 2 2 2 2 2 2 2 2
3. TB Response Challenges: human and
financial resource, programmatic
• Human resources
– Stigma, low financial compensation, and perceived risk
affect recruitment; lack of sufficient staff results in over-
work; in combination these result in high staff turn-over
– Need for training on new approaches and techniques

• Financial resources
– GVN budget: grossly insufficient, barely covering DOTS
– Heavy dependence on external funding for PMDT, TB/HIV,
PPM, ACSM, high risk groups in context of rapidly
decreasing funding
– New diagnostic tools: promising but expensive
Funding levels & gaps, 2013-15 (1)
Financial Need (USD) 2013 2,014 2,015 Total
Objective 1: High quality DOTS 48,557,537 54,067,373 49,350,967 151,975,876
Objective 2: TB/HIV, MDR-TB,
6,449,221 7,254,870 8,267,339 21,971,429
Closed settings
Objective 3: HSS 3,445,845 4,310,847 4,487,344 12,244,036
Objective 4: PPM 2,814,085 2,164,900 2,154,153 7,133,138
Objective 5: ACSM 4927475 4934582 4633739 14,495,796
Objective 6: Surveillance and
393,000 1,577,764 435,000 2,405,764
research
Total (in US$s) 66,587,162 74,310,335 69,328,542 210,226,039
Funding levels & gaps, 2013-15 (2)
Financial Gap (USD) 2013 2014 2015 Total
Funding needs 2011-
66,587,162 74,310,335 69,328,542 210,226,039
2015
Estimated fund
Central Gov’t budget 5,500,000 6,000,000 6,500,000 18,000,000
Provincial Gov Fund 4,741,607 5,435,115 6,152,621 16,329,343
Global Fund 10,503,688 10,616,383 11,495,842 32,615,913
TB CARE I (PEPFAR) 3,900,171 3,900,171 3,900,171 9,600,342
EXPAND TB In-kind n/a n/a
CDC (PEPFAR) 293,000 293,000 293,000 879,000
Total in US $s 24,938,466 26,244,669 28,341,634 79,524,769
Funding Gap, US $s 41,648,696 48,065,666 40,986,908 130,701,270
Programmatic challenges
Challenge Intervention
Ss(-) & EPTB increase HIV/TB
Relapse/failure/default cases & reTx after default DOT / PMDT
increase
High CNR + poor Tx outcomes in congregate TB control in
settings congregate
settings
High Tx success rate, but high prevalence rate and + PPM
~40% incident cases untreated each year
Very low CNR among children less than 14 years Childhood TB
control
Strengthening of recording/reporting