Catalysing efforts to optimize Viet Nam’s tuberculosis diagnostic network

Vietnamese version

The Viet Nam Countrywide TB Diagnostic Network Optimization (DNO) project aims to optimize the country’s diagnostic system for TB and improve the TB sample referral network, thus enhancing access to TB diagnostics and advancing TB control efforts in Viet Nam. As part of this work, FIND Viet Nam hosted a DNO training and review meeting.

This meeting fostered constructive discussions around aligning the analysis of DNO outputs with the National Strategic Plan (NSP) for TB Control for 2024–2026. The meeting achieved high-level consensus between FIND Viet Nam and the Viet Nam National TB Control Program (VNTP) around how to continue the implementation of DNO during the upcoming phase.

As part of the framework of the Viet Nam Countrywide TB DNO project (TB DNO Phase II in Viet Nam), FIND Viet Nam hosted a DNO introduction, training and review meeting for leadership-level colleagues, from 26 to 27 May 2023, in Ha Noi , Viet Nam. The discussions were co-chaired by Assoc Prof Nguyen Binh Hoa, Vice Manager of VNTP and Vice Director of the National Lung Hospital (NLH), Assoc Prof Nguyen Van Hung, Head of the Department of Microbiology and the National TB Reference Laboratory (NRL), and Dr Nguyen Thi Van Anh, Head of FIND Viet Nam. Also participating were key personnel and partners from VNTP, the World Health Organization (WHO), the KNCV TB Foundation and FHI 360. The meeting aimed to acquaint participants with the fundamental concepts, core processes, and principles underlying the application of DNO, while also presenting the outcomes of an initial baseline analysis. Furthermore, the meeting facilitated constructive discourse around future optimization scenarios that must be analysed in line with the NSP for 2024–2026.

At the meeting, the OptiDx software application was introduced. OptiDx, an innovative solution developed by FIND and its partners, is dedicated software that can be used to improve data-driven diagnostic system design. This software utilizes national data to generate digital models of a country’s existing diagnostic network, enabling the development of optimized models for the allocation of available resources and expanding the population’s access to timely, equitable, cost-effective and quality diagnosis.

In 2021, a DNO analysis for TB in Viet Nam was jointly conducted by FIND and VNTP (DNO Phase 1 in Viet Nam). This focused on the TB diagnostic network in nine provinces (An Giang, Can Tho, Dong Nai, Tay Ninh, Thai Binh, Ha Noi, Ho Chi Minh, Nghe An and Tien Giang). The work involved mapping and analysing the existing diagnostic network and modelling the impact of scaling up molecular testing from 10% to 62% of total TB tests between the financial years 2021 and 2023.

For the TB DNO Phase II in Viet Nam, DNO will continue to be implemented across all of Viet Nam’s 63 provinces and cities, throughout 2022 and 2023. The focus will be on supporting VNTP in effectively implementing the molecular diagnostic system for TB and drug-resistant TB (DR-TB), as well as optimizing the sample referral network, in line with the Global Fund proposal for the period 2024 to 2026. The project’s overarching objectives are to support NLH-VNTP in building capacity for the independent implementation of DNO, define and implement optimization models, and generate actionable outputs to inform decision-making and planning processes.

Designing optimal diagnostic systems is complex and highly context-dependent, requiring multiple data inputs and assumptions. In a resource-constrained country such as Viet Nam, this task is of huge importance. Assoc Prof Nguyen Van Hung, Head of the Department of Microbiology and the NRL, noted that patients often face formidable barriers to gaining timely access to life-saving diagnostics, while the molecular diagnostic system, such as GeneXpert for TB and DR-TB, remains either under-utilized or overburdened, resulting in the inefficient allocation of resources that could otherwise be better concentrated in areas with greater demand. Consequently, DNO has emerged as a potentially pivotal approach that harnesses the power of data to optimize diagnostic systems and bolster access to TB diagnostics.

The training workshop incorporated salient details of DNO, including a foundational introduction to DNO and the principles of its implementation in real-world settings. The session fostered unanimous consensus around the future scenario analysis model for DNO Phase II, which included dedicated support for the GeneXpert system implementation plan and the optimization of the sample referral system, in accordance with VNTP’s Global Fund proposal for 2024–2026. Additionally, concrete plans were laid out to enhance the competence of VNTP personnel in effectively utilizing the OptiDx software and to chart a clear direction for its seamless integration in the upcoming 2024–2026 phase.

During the training workshop, Dr Nguyen Thi Van Anh, Head of FIND Viet Nam, expressed strong confidence that “DNO is a crucial pillar of FIND in supporting the VNTP and promoting TB control efforts in Viet Nam.” She emphasized FIND’s steadfast commitment to collaboration and capacity building with the VNTP to optimize resource allocation and improve access to testing, with the aim of achieving the national goal of TB elimination.

Ms Juhi Gautam, FIND’s Access Officer and DNO Coordinator, added: “DNO as a geospatial analysis approach is helping ministries of health in many countries to analyse their existing diagnostic network and identify strategies that improve access to testing while making the best use of available resources. In these countries, DNO works best when the analysis and implementation is led by ministries of health, with support from technical experts and partners within countries. FIND is working alongside our partners to bring the power of data analytics to diagnostic network strengthening.”

The success of the meeting was exemplified by the resolute consensus around the roadmap for the future implementation of DNO for TB control in Viet Nam, with VNTP expressing its hope that FIND, alongside the use of the OptiDx tool, will continue to provide effective support for VNTP, facilitate the optimal design of an efficient sample referral system and ensure technology transfer upon the project’s culmination.