TUBERCULOSIS TREATMENT DELIVERY AND RESULTS OF SCC IN VIETNAM
DR. LE BA TUNG 14/2/1997
I. INTRODUCTION:
I.1 Tuberculosis situation in Vietnam:
Population (1995): 72,891,000. Administration division :53 provinces and cities. 567 districts. 10,116 communes : Tuberculosis is a major public health problem. The annual risk of TB infection (ARI) is 1.5% (1% in the North and 2% in the South).
1.2 National TB Programme network : There are 3 levels.
* National level: National institute of TB and Lung disease (NITLD) at Hanoi and Pham Ngoc Thach TB and LD in Ho Chi Minh City carries - out the implementation of NTP in the Southern region (Region B2) via the NITLD.
*Provincial level: Provincial TB center.
*District and commune levels: District TB section and health post at commune level.
The NTP is integrated in the primary health care system and mainly implemented at district and commune levels. The district TB section has a TB consulting room with microcopy facilities. (at least 3 TB workers/100,000 habitants) and 5 - 10 beds of TB in - patients. with 2 main functions. Passive case - finding based on direct sputum examination and Organization of ambulatory treatment with close supervision at least of the initial phase.
The health post at commune level has 4-8 heath workers of whom one is responsible for social disease control, one of which is TB. There ere 2 main tasks : Identification and Referral of suspect TB to distrait TB section for sputum examination and Realization the supervised treatment under the indication from district TB section staff.
-The NTP started before 1975 and was revised in 1986. The NTP follows the main directives of WHO IUATLD. The NTP was officially recognized by the government.
-Regimens of TB treatment:
Since 1986: for new cases (AFB+) 3SHZ/6S2H2
for retreatment cases (AFB+) 3HRE/6H2R2E2
Since 1989: for new cases (AFB+) 2SHRZ/6HE (to be introduced gradually)
Since 1997: for new smear negative pulmonary and extrapulmonary TB cases: 2HRZ/6HE.
The NTP has been supported by many NGO: MCNV,KNCV,CIDSL, JUNTLD, WHO...
Until the end of 1995 : 90.4% of general population covered by NTP. 91.4% of districts having DTB sections : 85.2% of communes having their TB health workers. SCC implemented in 48% of districts occupied 56% of the total population from 1989 to 1995.
II. TUBERCULOSIS TREATMENT DELIVERY:
2.1 All new smear positive pulmonary TB patients admitted in the treatment with SCC
regimen 2SRZ/6HE and relapse and failure smear - positive cases with retreated regimen 2SHRZE/1HRZE/5H3R3E3 from 1989 to 1994 in Vietnam, were assessed and analyzed. Definitions of patients enrolled on D.TB Register are identical with those recommended by WHO and IUATLD.
2.2 Since 1989 patients enrolled on SCC regimen 2SHRZ/6HE receive the intensive phase of treatment according one of the following 4 methods: (D.O.T.S.)
+ On ambulatory bases, fully supervised by the staff of D.TB section provided that the distance from the patient's house to the D.TB section is less than 3km.
+ On ambulatory basis, supervised by the staff of intercommunal satellite spots (at intercommunal polyclinical consulting room)
+ On ambulatory, supervised by the strong staff of health posts in the remote rural areas provided that : the TB health workers are well trained on the treatment and management of TB and that they are supervised monthly by the District - TB staff.
+ As in- patients in the district hospital.
2.3 During the continuation phase (6HE): Drugs are self - administered by the patients at home in the following two settings.
+ In urban areas: patients are instructed to attend monthly to the district TB section for review and collection of an one monthly supply of drugs.
+ In rural areas: D.TB staff visit the health- post monthly in the fixed day to review the patients and to distribute the drugs.
+ The communal TB health worker have to visit the patients twice monthly at home to ensure that drugs are correctly taken and to check about the side-effects (well compliance of TB patients).
