Improving TB Detection and TB-HIV Services Integration

Overview

Working closely with the National TB Program, the Vietnam Administration for HIV/AIDS Control, and provincial health departments, URC is providing technical support to improve the quality of and integrate treatment services for TB and HIV in two provinces.

The activities build upon prior work through the USAID Health Care Improvement (HCI) Project and the Quality Assurance Project. At the national level, the USAID Quality Assurance Project provided technical assistance to the National TB Program and Vietnam Administration of HIV/AIDS Control to develop a national framework, guidelines, and training modules on TB-HIV integration in 2007.

At the provincial level, the project assisted the Thai Binh Province in improving TB and TB-HIV integrated services through the USAID-funded Quality Assurance Project and its successor the Health Care Improvement (HCI) project during 2007-2011.

Key Activities
  • Provide training and mentoring for hospital and health center staff in TB-HIV co-infection prevention, diagnosis, case management, and referral procedures and in the use of quality improvement tools and approaches
  • Support provincial TB coordinators in organizing monitoring and evaluation efforts to measure compliance with TB-HIV standards
  • Assist provincial TB teams in engaging private providers in TB diagnosis, case management, and referral
  • Design and promote the use of district and provincial databases and monitoring forms for record keeping related to TB patients’ care and outcomes
  • Strengthen infection control and the response to multi-drug resistant TB in the target provinces
Achievements

The work builds on best practices and approaches developed by the Health Care Improvement Project (HCI) in Vietnam and the Quality Assurance Project.

TB-HIV Integration

Working closely with provincial and district partners, the project supported the provincial TB and HIV programs in better integrating TB and HIV services, drawing on available resources of the programs and projects. 

The project assisted all the TB and HIV health facilities at provincial and district levels in building capacity for provider-initiated HIV counseling and testing in Thai Binh Province. The HIV testing rate among new TB patients increased from 19% in Q1/2007 to 81% in Q3/2009. Similarly, in the Nam Dinh and Hai Duong provinces achieve 100% coverage for HIV counseling and testing (HIV CT) at the district level by enabling provision of free HIV CT services for TB patients in all districts that did not receive other project support. In those districts, the project facilitated HIV test kits; counseling and testing for TB patients; and training courses and joint monitoring visits for staff from both TB and HIV programs to improve quality of HIV CT in the entire provinces. As a result, the increased HIV CT percentage in those districts contributed to the improvement of HIV CT services in the provinces as a whole:  from 84% in Quarter 1/2010 to 99% in Quarter 1/2011 in Nam Dinh Province and from 56% to 83% in same period in Hai Duong Province.

The project also resulted in an increased treatment success rate through strengthened Directly-Observed Treatment Short course (DOTS), partially attributed to improved collaboration between TB and HIV programs, and strengthened M&E.  The TB treatment success rate increased from 59% to 92% for TB-HIV patients enrolled for TB treatment in Nam Dinh, and from 59% to 91% in Hai Duong.

Public Private Mix (PPM) in TB Control

In all provinces, improved PPM collaboration resulted in increased numbers of TB patients diagnosed. In Thai Binh Province, PPM’s contribution to TB case detection increased from 1.6% to 8.3% of TB confirmed patients between 2007 and 2009.  In Hai Duong Province, PPM interventions significantly contributed to an annual increase of 20% in TB case detection rate at district level in 2010.

Strengthened Routine M&E system

The project also developed a user-friendly PPM database in two provinces.  The database stimulated regular data analysis, reporting, and use for strategic decision making and feedback for continuous collaboration improvement.

Duration
2011 to present
Funders 
University Research Co., LLC (URC)
Regions/ Countries 
Geographic Scope 
Hai Duong and Nam Dinh provinces