TODAY -

It's Time: Match words with actions to #endTB

Bobby Ramakant *

 Dr Nguyen Viet Nhung, head of national TB programme in Vietnam and Director of National Lung Hospital, Hanoi
Dr Nguyen Viet Nhung, head of national TB programme in Vietnam and Director of National Lung Hospital, Hanoi



Alongside boosting research and development of new tools to prevent, diagnose and treat TB, there is an acute need to optimally deploy and maximally utilize existing tools for preventing, diagnosing and treating TB, says Dr Nguyen Viet Nhung, head of national TB programme in Vietnam and Director of National Lung Hospital, Hanoi.

Dr Nhung was conferred upon the 'Honorary Associate Professor' title by University of Sydney Central Clinical School, Faculty of Medicine and Health, on 13th December 2018 (a day after the Universal Health Coverage Day - UHC Day).

Mind the gap: It's Time, to be honest

Are we doing all what we can, to end TB? Dr Nhung acknowledges the funding gap in the global fight against TB, especially the resource crunch which is slowing down research and development (R&D) of new tools for preventing, diagnosing and treating TB. "Funding gap for TB R&D is very big, US$ 1.2 billion per year. If we don't have this funding gap then new effective tools for preventing, diagnosing and treating TB may come out sooner" says Dr Nhung.

More importantly Dr Nhung points out that gap is not only in funding, but also between what-we-can-do to end TB and reality on the ground. Business as usual is not an option and we have to maximally utilize all evidence-based ways to prevent, diagnose and treat TB, while we accelerate science for finding better tools.

Doing TB control more effectively

Innovation is not only about finding new tools, but also about finding better ways of doing what-we-know-works more effectively in TB control. "In Vietnam we not only pay attention to R&D but also to innovation. We apply new tools in optimal ways" said Dr Nhung. For example, new molecular test (cartridge based bucleic acid amplification test) GeneXpert, has been deployed in more efficient manner in Vietnam.

Dr Nhung further explained: "X-ray is very sensitive for TB screening but not for confirming the disease. If we screen people using x-ray first, and those who are found with abnormalities consistent with TB, are tested with GeneXpert, then it is not only optimal but also a cost-effective strategy. We have increased active case finding which has now reached above 90% now."

Scientific evidence must shape policies and programmes

Dr Nhung said that well-documented studies provide the data for decision making on policy innovation and scale-up of new interventions in Vietnam. "There are gaps in implementation of TB control too, which can be bridged by better management, resource maximization, and using budget to support key activities, integration of services and making services friendly and accessible to our clients (patients)" reflected Dr Nguyen Viet Nhung.

We cannot ignore sustainability, said Dr Nhung, as it is vital to ensure full support to fight against TB till the 'finish line'. At the United Nations High Level Meeting (UNHLM) in September 2018, Dr Nhung was among those who advocated with heads of nations to end TB. Since then, TB is rising up on the agenda of Vietnam's national commission which is tasked with multistakeholder accountability framework. This may soon reflect in the law, approved by the national assembly, and eventually result in national action plan to end TB by 2030. A very concrete development, said Dr Nhung.

Communities: cog in the wheel to #endTB

Dr Nguyen Viet Nhung rightly says that gap in involvement of community at every level of the fight against TB cannot be ignored, if we are to end TB. "What use will be state-of-the-art diagnostics, treatment and care if people who are in need, are unable to use it?" Scientific innovations such as vaccines will have to reach all those who need them, otherwise we are failing to convert scientific breakthroughs into public health gains.

"We need to bring healthcare services and people who need these services, together! We have to narrow the gap between provider and client, where client is community and not just the patient" emphasized Dr Nhung. Reducing and eventually ending TB related stigma is of prime significance, said Dr Nhung.

Catastrophic expenditure is blocking progress

Dr Nguyen Viet Nhung emphasized on yet another major obstacle which impedes efforts to fight TB: catastrophic expenditure. Even when TB diagnostics and drugs are free, there are a range of medical and non-medical costs that become a barrier for people with TB. All countries including Vietnam had unanimously supported the adoption of the World Health Organization (WHO) End TB Strategy in May 2014 World Health Assembly, of which, promise to end catastrophic expenditure is among the major pillars.

Dr Nhung stresses on the need to have local data to estimate TB costs so that locally feasible solutions can be found to reduce or eliminate such barriers. "We can seek support from foundations or charity or health insurance systems to ensure there is no medical cost that is preventing people from accessing TB care. We have a patient support foundation to end TB in Vietnam to help those who get diagnosed with TB (especially those who do not have health insurance card).

This foundation also helps patients when they need to be hospitalized. Non-medical expenditure is the bigger chunk of catastrophic expenditure for TB patients. Universal Health Coverage (UHC) will help reduce some of these costs, as well as, making healthcare services friendly and easier to access at the grassroots will help. We have to help establish and strengthen community based management to avoid hospitalization when possible, said Dr Nhung.

Dr Nhung recommended to engage other non-health sectors such as labour sector to minimize or eliminate labour or income loss for those who seek TB care. By working together with labour sector and other stakeholders we should agree on a labour policy to support TB patients.

"Without the involvement of the community we cannot end TB", if we are to end TB, we need to find solutions with community and break down all barriers to TB care, emphasized Dr Nguyen Viet Nhung.

Rehabilitation is integral part of healing and care

"Previously we only thought of bacilli but now we have to think beyond treating the disease, and focus on the patient's wellbeing. Patient may be cured of TB but despite being cured, lives with consequences of getting TB, such as, large scar in the lungs. Another example is sometimes chronic TB can cause severe COPD (Chronic Obstructive Pulmonary Disease). Rehabilitation is a very important part of TB care. In Vietnam we have developed Rehabilitation Treatment Programme which not only includes treatment with medicine but also has more comprehensive elements, such as exercises etc, to support rehabilitation of the patient."

Empty the pool of latent TB to #endTB

"Addressing latent TB is a very important component of the strategy to end the epidemic. When we treat latent TB, the new infection (not disease) is very different from primary infection because the other infection has already been killed, which results in patient developing immunity against TB. Globally we have set a target of providing TB prevention treatment (for latent TB) to 30 million people between 2018 and 2022, based on new WHO guidance. This target is not ambitious, and we think, it has to be much more!" said Dr Nhung.

Dr Nhung suggests that target to provide preventive therapy to people with latent TB should at least be 60 million by 2022.

One of the challenges slowing progress on addressing latent TB is lack of diagnostics that can be scaled up to the required level of potential public health impact. Unfortunately, there is no gold standard diagnostic test for latent TB infection, and existing tests have poor ability to predict which individuals will go on to develop active TB disease. Tuberculin skin test is not specific enough and Interferon Gamma Release Assay (IGRA) tests (like Quantiferon) are "complicated (need specialist laboratory processing) and expensive" says Dr Nhung. "We cannot do it for everyone in a programmatic setting."

But there is some hope: "C-Tb is a novel specific skin test developed in Denmark, Europe, based on 2 specific antigens (ESAT-6 and CFP10), and results are unaffected by BCG vaccination status." Such tests which can be used in programmatic settings of high-burden TB nations, with good specificity and sensitivity, can potentially jump the numbers of people receiving preventive therapy for latent TB, says Dr Nhung.

Cost is another barrier: preventive therapy for latent TB (based on rifapentine and isoniazid regimen) is very effective but expensive: "we need to find a way to do global negotiations for quality assured standardized drug procurement so that we can reduce the cost of this regimen and make it more affordable for people" said Dr Nhung.

Dr Nhung committed that with the support of the Global Fund to fight AIDS, TB and Malaria (The Global Fund), Vietnam is likely to aim for much bigger targets for addressing latent TB in the country, compared to global goals. Dr Nhung also underlined the importance of research to evaluate the impact of this latent-TB-intervention in reducing the epidemic and hoped it will be studied in near future in Vietnam.

Rollout of Bedaquiline in Vietnam

Bedaquiline is among the only two new TB drugs that have been approved over the last 40 years. Although phase-III clinical study is still going on, Bedaquiline, was provided marketing authorisation by the US-FDA under a procedure of "accelerated approval" for the treatment of MDR-TB, in December 2012. By end of September 2018, over 70,000 cumulative treatments of Bedaquiline-based-regimens were given in 108 countries.

"Bedaquiline is very important for TB control especially when we think of ending TB. Bedaquiline rollout began in Vietnam two years ago. Its first pilot with 100 eligible patients (with pre-extensively drug-resistant TB or extensively drug-resistant TB) have successfully been completed last year. We extended the pilot to another 100 eligible patients and have almost met the target. Treatment outcome is very good with over 80% success rate, and side-effects remain under control" said Dr Nguyen Viet Nhung. For all patients of multidrug-resistant TB (MDR-TB) we offer the WHO approved short regimen. We need to reserve the new drug for patients who have exhausted current treatment options."

Dr Nhung cautioned on cross-resistance between new drug Bedaquiline and Clofazamine. To avoid cross-resistance in Vietnam, patients who have a history of taking clofazamine, are not eligible for Bedaquiline.


* Bobby Ramakant, CNS (Citizen News Service), wrote this article for e-pao.net
The writer is the Policy Director at CNS (Citizen News Service) and received the World Health Organization (WHO) Director-Generalís WNTD Award in 2008. Follow him on Twitter @bobbyramakant, @CNS_Health or visit: www.citizen-news.org
This article was webcasted on December 29, 2018.



* Comments posted by users in this discussion thread and other parts of this site are opinions of the individuals posting them (whose user ID is displayed alongside) and not the views of e-pao.net. We strongly recommend that users exercise responsibility, sensitivity and caution over language while writing your opinions which will be seen and read by other users. Please read a complete Guideline on using comments on this website.




LATEST IN E-PAO.NET
  • Chayom Thupki (Meetei Philosophy) #12
  • Shirui Lily Fest - Inauguration : Gallery
  • 'Unethical act of few Orgs of a community'
  • In defence of ancestral land and freedom
  • Not just twin but triple demands of NSCN-IM
  • Govt College Teachers' Assn : GBM
  • The Killing Fields 2013-19 : News Timeline
  • Pressing need for sanity to prevail
  • Forgotten pledge - a reminder
  • 123rd Lamyanba Irabot #3 : Gallery
  • May all the roads lead to Ukhrul ..
  • AMAND Cultural @Pune #2 : Gallery
  • Naga Flag & Constitution is our Identity
  • Global Handwashing Day
  • Gwangju Prize for Human Rights: Nominate
  • German program for women entrepreneurs
  • Raising the integration bogey, again
  • October 15 and the GoI
  • NTC calls for solution within scheduled time
  • Naga peace talks deadlocked
  • Pot Lannaba : Houchongba #1: Gallery
  • IM & Govt against freedom fighters
  • Wijaidin Pamai @Intl Fashion Week Goa
  • SheChef Season 2, Shirui Lily Festival 2019
  • Crazy for the hole :: Poem
  • Intl Classical Manipuri Dance Festival
  • Putting a check on single use plastic
  • Harvesting the green gold
  • Mera Houchongba @Kangla #1: Gallery
  • Mera Houchongba festival
  • Intl Day for Disaster Risk Reduction
  • Understanding JAM for bright career
  • For you, I gave up everything : Poem
  • Paranoia of Beauty: A Corporate Brainwash
  • Naga Peace Process :: News Timeline
  • Opening NE to outside world: Challenges ..
  • Contested Identity Along Myanmar Border
  • NNPGs mandated for solution: Isak
  • Wont walk path of capitulated peace: IM
  • 3-month deadline ..unacceptable: Hoho
  • Manipur Street in Manchester & Shirui Lily
  • A glimpse of Shirui Flower : Gallery
  • World within a World
  • Face of RaDiant Group
  • For the Common People :: Poem
  • Heart Camp at Senapati District Hospital
  • NDPP is 'verba non facta' : NPF
  • Swindling of Public Money
  • Bor khoiramba @Hiyangthang #2 : Gallery
  • Lansinganglu, Ahinglang : eMing
  • World Tourism Day @Noney #3 : Gallery
  • World Mental Health Awareness Week 2019
  • Manipur lost legacy- Merger Agreement #2
  • My aquamarine :: Poem
  • Rice for beauty
  • Stand off over flag and constitution
  • Suicide - Western docs, Psychologists...
  • Naga wont accept alien doc. as constitution
  • Manipuri Calendar 2020 :: Download
  • AMAND Cultural @Pune #1 : Gallery
  • Inner Line Permit (ILP) Demand : Timeline
  • NE Message of Cleaninness at Delhi
  • Research Support Officer @ Amethyst
  • 8th AGM/Annual Cultural of AMAND, Pune
  • Peace & conflicts studies as a career
  • College student leaders learn leadership
  • Reaffirming stand of 2016 unity
  • Mr. Chief Minister, clean the dirt...
  • Nongdol Leima @ JNMDA #2 : Gallery
  • Haloi Taret: Dangerous Beauty....
  • Difficult days ahead for Muivah
  • Manipur from Independence to Merger #3
  • World Mental Health Day, 2019
  • Traditional DJ
  • Cry of a Dying River - 96 :: Poem
  • ..district to State level : Shirui Lily Festival
  • Something is still not right
  • Chothe Achui Lin festival #2
  • Heritage Park @Sangai Fest #3: Gallery
  • Are we being bullied with same fake news?
  • Hard facts about the betrail
  • World Animal Day 2019
  • Academic Entrepreneurship at MU #2
  • Nagas of Nagaland : Drawing the divide
  • ... Manipur needs strategic change
  • World Tourism Day @Noney #2 : Gallery
  • ST status is to save indigenous community
  • Sangai festival and tourism multiplier
  • Governance, Gender & Environment :: Book
  • Now Your Hair :: Poem
  • Neiphiu Rio's myopic belief on ILP : NPF
  • Probe into maladministration of hospital
  • Taking high moral stand: Begone moral cop
  • Bor khoiramba @Hiyangthang #1 : Gallery
  • Manipur lost legacy- Merger Agreement #1
  • Sikkim Dance @Sangai Fest: Gallery
  • World Habitat Day: A celebration for home
  • For Your Eyes Only :: Poem
  • No School bag day in Manipur
  • Making ban on single use plastic effective
  • New CAB clause to protect NE : HM
  • NNPGs ready to conclude talks: Kitovi
  • 123rd Lamyanba Irabot #2 : Gallery
  • Ngangom Chaoba : Natyabhusan
  • Ganja economics, Jai Bholenath !
  • Soul Sister :: Poem
  • Leap of faith on wings of Prayer
  • Counselling: Children in Conflict with Law
  • Caution for the cocksure
  • CAB Protest @Khwairamband : Gallery
  • Manipuri Women & Crime Against them
  • Toward exploring a better future for youth
  • I happily cry :: Poem
  • NE Students' Culturals at Pondicherry
  • Beauty benefits of banana
  • Heart Camp at District Hospital, Chandel
  • Contained but final word yet to be said
  • Smart idea, bumbling idealists
  • Chingda Satpi Engellei #2 :: eRang
  • Facts & Opinions: Integration of Naga Area
  • Licypriya : Earth Day Network 'Rising Star'
  • Cry of a Dying River - 95 :: Poem
  • Khangminashi - V at Ibotonsana Hr Sec
  • Academic Entrepreneurship at MU #1
  • Vote BJP but protest: CAB Indecisive stand
  • Significance of Manipuri proverbs
  • Hathei Phanit (Chilli) #2: Gallery
  • Naga insurgency & peace condition #2
  • World River Day, 2019
  • Half Brother :: Poem
  • Youth Essay Contest: May 18 Memorial
  • Michelle Salam : Top Ten Cake Masters
  • Internal tussle within the Government
  • The humility of MK Gandhi & Manipur
  • Bhagyachandra Death Anniv @WB : Gallery
  • Why dont Manipur forget Merger Agreement
  • Let us celebrate Non Violence Day
  • Looking Forward to a Sexy Evening : Poem
  • Observance of Senior Citizen's Day
  • Turmeric in beauty care
  • Artists for NH7 Weekender, Meghalaya
  • Parking madness at commercial centres
  • Demise of a dream
  • 123rd Lamyanba Irabot #1 : Gallery
  • International Day Of Older Persons, 1 Oct
  • Licypriya : India Peace Prize : Gallery
  • Irabot the poet of the working class
  • October Calendar for Year 2019 : Tools
  • Licypriya Kangujam : India Peace Prize 2019
  • ST status demand for Meiteis widening rift
  • Certificate Course on Neuropsychology
  • Lining up stand against CAB
  • Remembering Lamyanba & his politics
  • Irabot Day & the practice of volunteerism
  • Lamyanba Hijam Irawat :: Read articles
  • Around India in 60 days
  • Nungleiband Massacre: Diary of Editor
  • Judo: Rishikanta, Roshibina, Kalpana
  • Heart of an empowering woman : Poem
  • Imphal Peace Museum: Best Design Award
  • Engaging with the young minds
  • Lai Khutsangbi & female power
  • Naga liberty or forced disintegration..
  • Irabot's letter to Assembly: 18 Oct 1948
  • Monika Ingudam: Natl Youth Icon Award
  • Heart Camp at District Hospital, Ukhrul
  • Swacchata Hi Seva at Lakoipat
  • Let 'tree' that was cut, be the last
  • World Tourism Day @Noney #1 : Gallery
  • Where All The Flowers Gone? #2: Gallery
  • The resurgence of Hijam Irabot
  • Naga insurgency & peace condition #1
  • World Heart Day 2019
  • Judo: L Sushila; M Bidyashori, T Inunganbi
  • Counselling: Children in Conflict with Law
  • Looking to increase revenue collection
  • Adapting with the changing time
  • Inamma - Film Scenes #1 :: eRang
  • Heritage Park @Sangai Fest #2: Gallery
  • Cry of a Dying River - 94 :: Poem
  • Reject false solutions to climate crisis
  • Career in Mass Communication
  • Ideals of Lamyanba Irawat
  • Laurels for Th Brinda, Ng Touthang
  • Performances to watch at NH7 Weekender
  • Protest in NE against CAB starting Oct 3
  • Bamboo bus shelter model developed
  • Noney to host World Tourism Day
  • Drought and the drainage issues
  • Marangwon @Kangkhui Khullen: Gallery
  • The flavor of Utsav Tarpon
  • Urgent Need to Reconsider Naga History
  • A woman :: Poem
  • Human Papilloma Virus & women's health
  • Meeting the Enemy at Nathu La
  • 'Outburst' of Thuingaleng Muivah
  • Concerns for media persons
  • Ibudhou Thangjing Haraoba #5 : Gallery
  • Licypriya Climate March @Angola :Gallery
  • Featured Front Page Photo 2019 #4: Gallery
  • Licypriya Climate March at Luanda :: Report
  • Workshop on Science Writing
  • Nurabi, nominated at Rio WebFest
  • Manipur retain Senior Women's NFC title
  • Robert Naorem : Best Intl Fashion Designer
  • Process of updating electoral roll
  • Ban on plastic use
  • Kartal Cholom @ Sangai Fest : Gallery
  • Reflection on Tolstoy, Irawat & Dr. Kamal
  • Local solution, local action for #GlobalGoals
  • In You I Find My Sunset :: Poem
  • ... denying rights in actual practice
  • Landslide: Are Mitigation measures effective
  • Emotional Intelligence: Yardstick for life skill
  • eNabling North East Award 2019
  • The debate over legalising ganja
  • The new MVA; how serious is the govt ?
  • Chothe Achui Lin festival #1
  • Lady E-Rickshaw driver inspires women..
  • M Shanker: Indian Achievers Award 2019
  • Softly Coo the Wild Pigeons :: Poem
  • Discussion on Manipur Merger Agreement
  • Irabot, one & only leader of oppressed mass
  • Start-up Manipur as a potential launch pad
  • Culture Students Foundation Day : Gallery
  • Eyek Tamba :: Learn Manipuri script
  • Territorial Integration, Flag or Constitution
  • Book published on Irabot Day: Download
  • In love with the night :: Poem
  • Maverick mind of Ram - Dedicated to Bar
  • Smoking- silent killer for your backbone
  • Revisiting Sept. 21 (1948 & 1949)
  • Where All The Flowers Gone? #1: Gallery
  • BCIM Corridor & China New Transportation
  • Alzheimer's Awareness Month
  • Cry of a Dying River - 93 :: Poem
  • Rally & Youth's Voice on Climate Change
  • Guwahati to Bangkok : Direct Flight
  • Stringent traffic rules in place
  • Time for immediate solution to climate crisis
  • Traditional Dress of Hmar : Gallery
  • Licypriya @UNESCO Forum, Angola: Gallery
  • 46th AMWJU Foundation Day : Gallery
  • Heikru Hidongba #2 : Gallery
  • 48th Foundation Day of RIMS : Gallery
  • Chaklam Khongchat Numit #4: Gallery
  • Mukna - indigenous game : Gallery
  • Babysana's last rites performed: Gallery
  • Tolloi, Ukhrul :: 360 Panorama View
  • SPONSORED ADS