Vietnams TB programmes facing new challenges

Despite enjoying 'success story' status for nearly a decade, Vietnam's tuberculosis (TB) programmes are facing several new challenges. Vietnam has the 13th highest incidence of TB in the world and while the country's TB programmes are considered a model for Directly Observed Treatment, Short-Course (DOTS), there are no signs of a decline in the overall annual incidence of the disease.

Dinh Ngoc Si, the Director of Vietnam's National TB Control Programme, told a recent workshop in Hanoi that increases in drug resistance and the number of dually infected HIV/TB patients posed new challenges to health care services. "HIV infection makes tuberculosis harder to treat. An increasing number of people with TB were also developing drug resistance, which could affect the country's treatment success rate" Dinh was quoted in press reports as saying.

Vice-Director of the National Institute of Tuberculosis and Lung Disease Nguyen Duc Duong backed up Dinh's comments saying that, "Challenges facing the programme include controlling TB in remote areas, especially because of the spread of HIV/AIDS and increased drug resistance." HIV has been detected in all 64 of Vietnam's provinces and the country is rapidly expanding its distribution of antiretroviral drugs (ARVs). But if the factors contributing to increases in the prevalence of drug resistant TB are not tackled, it could become a more serious concern.

It has also been difficult for Vietnam to extend its TB control and ARV programmes to lower-income and ethnic minority communities. A lack of health literacy has led to delays in the diagnosis and treatment of TB in some Vietnamese patients with many dropping out of treatment regimes. As sex work, injecting drug use and same-sex sexual relationships are considered criminal in Vietnam, TB and HIV health care providers struggle to reach high-risk communities and patients face considerable degrees of discrimination and stigma when attempting to access health services.

On top of these limitations, more resources are also needed. According to estimates, national TB programmes will need US$ 48 million between 2007 and 2011. A stronger policy and institutional environment needs to be cultivated in Vietnam if TB and HIV programmes are to be successful, and health care services tackling the two diseases need to be integrated to maximize their impact. The comprehensive monitoring of TB and antiretroviral therapy (ART) programmes is also important to ensure they function optimally and to prevent the widespread emergence of drug resistance in Vietnam. Unless sustainable services are made available to affected communities, including those in hard-to-reach areas, and work is done to reduce stigma and discrimination, Vietnam's TB programmes will remain inadequate.

Bobby Ramakant-CNS

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