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Cycle 5 (2016 Deadline)
An assessment of smoking and access to care as risk factors for gender-differences in TB rates – a substudy of the Vietnam NTP TB prevalence survey 2016-2018
PI: Nguyen Van Hung (hungmtb75@gmail.com), Vietnam National Tuberculosis Program
U.S. Partner: Payam Nahid, University of California, San Francisco
Project Dates: March 2017 - February 2020
Project Overview
The global burden of 9.4 million annual cases of tuberculosis (TB) overwhelmingly falls on low-income countries, with 80% of cases occurring in just 22 high-burden countries. Between 1998 and 2008, the average male-to-female ratio of new smear-positive cases for high-burden countries was 1.85. Although every country is unique, gender differences observed in case notifications are often mirrored by gender differences in prevalent TB cases, indicating there are genuine gender differences in the biology and epidemiology of TB. Vietnam falls among the countries having the highest TB burden in the world, with an estimated incidence of around 140 new TB cases per 100,000 population annually. Additionally, the Annual Report of the Vietnam National Tuberculosis Program (NTP) notes that the program detects nearly three times more male than female TB patients in the notification rate of pulmonary TB.
Repeat TB prevalence surveys provide useful data on trends in the burden of disease caused by TB, and can also be used to assess the impact of efforts to control TB. In addition to the prevalence survey, this PEER project assessed smoking and access to care as risk factors for TB to determine the role smoking might play in creating gender differences among TB cases.
While the DOTS (directly observed treatment, short-course) strategy has become the standard treatment protocol for TB control in most countries, most current TB control strategies fail to account for the increased risk of recurrence due to smoking. A better understanding of the incidence of, and factors associated with, TB infection and recurrence may help in identifying the most vulnerable populations and developing effective control measures that lower the rate of TB infection. This study aimed to inform policy and program managers and identify gender-sensitive recommendations on smoking policy and prevention to improve current TB control policies and programs to reach Vietnam’s ambitious targets for 2020 and 2030.
Final Summary of Project Activities
The PEER team undertook a pilot research study at four sites, trained data collectors, and set up online data collection tools. They collected data on various elements of individuals seeking care for prolonged cough, including education and smoking history, through a survey questionnaire within Vietnam. Ten national research team members finished data collection in 120 selected clusters. The TB Prevalence Survey (TBPS) team organized a workshop to discuss data cleaning, validation, and analysis. Validation of data collected from the clusters was done by cross checking between digital and paper-based data. Preliminary data analyses of the TBPS data included multiple imputation and sensitivity analysis steps.
The researchers worked with external partners at the Dutch foundation KNCV, the World Health Organization, and the U.S. Centers for Disease Control and Prevention office in Vietnam to review their findings and develop a technical report. By the spring of 2023 they had published four papers, with the latest focusing on the gender aspects of TB rates in Vietnam. Given the close linkages between the project team and the relevant government agencies and programs, some results of the study were also expected to be used in developing the Vietnamese national strategic TB plan from 2021 to 2025.
Publications
Hai Viet Nguyen, Daniella Brals, Edine Tiemersma, Robert Gasior, Nhung Viet Nguyen, Hoa Binh Nguyen, Hung Van Nguyen, Ngoc Anh Le Thi, and Frank Cobelens. 2023. Influence of Sex and Sex-Based Disparities on Prevalent Tuberculosis, Vietnam, 2017–2018. Emerging Infectious Diseases 29(5): 967-976. http://doi.org/10.3201/eid2905.221476
Hai Viet Nguyen, Petra de Haas, Hoa Binh Nguyen, Nhung Viet Nguyen, Frank G.J. Cobelens, Veriko Mirtskhulava, Alyssa Finlay, Hung Van Nguyen, Pham T.T. Huyen, and Edine W. Tiemersma. 2022. Discordant results of Xpert MTB/Rif assay and BACTEC MGIT 960 liquid culture to detect Mycobacterium tuberculosis in community screening in Vietnam. BMC Infectious Diseases 22: 506. https://doi.org/10.1186/s12879-022-07481-5
Hai Viet Nguyen, Hoa Binh Nguyen, Nhung Viet Nguyen, Frank Cobelens, Alyssa Finlay, Cu Huy Dao, Veriko Mirtskhulava, Philippe Glaziou, Huyen T.T. Pham, Petra de Haas, and Edine Tiemersma. 2021. Decline of Tuberculosis Burden in Vietnam Measured by Consecutive National Surveys, 2007-2017. Emerging Infectious Diseases 2021;27(3): 872-879. https://doi.org/10.3201/eid2703.204253
Hai Viet Nguyen, Edine W. Tiemersma, Hoa Binh Nguyen, Frank G.J. Cobelens, Alyssa Finlay, Philippe Glaziou, Cu Huy Dao, Veriko Mirtskhulava, Hung Van Nguyen, Huyen T.T. Pham, Ngoc T.T. Khieu, Petra de Haas, Nam Hoang Do, Phan Do Nguyen, Cong Van Cung, and Nhung Viet Nguyen. 2020. The second national tuberculosis prevalence survey in Vietnam. PLoS ONE 15(4): e0232142. https://doi.org/10.1371/journal.pone.0232142
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