June 2017 – present
The IMPACT-TB project seeks to assess the facilitators and barriers to scale-up of two active TB case finding and comprehensive patient care models in Ho Chi Minh City, Viet Nam and the Central Development region of Nepal. This work is supported through two strategies: 1) comparing two alternative implementation strategies in each country appropriate to the local service delivery, and 2) assessing the health economic impact and social returns on investment of active case detection under the different models for transmission modelling of wider epidemiologic impact.
In Viet Nam, IMPACT-TB is implementing comprehensive care for TB in six districts: District 6, District 8, District 12, Binh Chanh, Hoc Mon and Tan Binh, and involves a comparison of intensified active case finding activities in these districts to six comparable control districts. In three of the intervention districts (District 12, Hoc Mon and Tan Binh), active case finding activities are carried out by salaried employees; in the remaining three districts (District 6, District 8 and Binh Chanh), a network of community volunteers will take on the work. The employment models will generate a comparative analysis on the cost-effectiveness and sustainability of healthcare worker model.
To improve diagnosis of TB across all implementation districts, we have scaled up screening on CXR and testing by Xpert MTB/RIF assay. To learn more about the “Double-X” algorithm and how active case finding is implemented in the districts, please click here.
In addition to implementing active case finding intervention activities, we are also conducting a pilot study that seeks to measure the feasibility and acceptability of providing Social Health Insurance (SHI)and conditional or unconditional cash transfers to patients with drug-susceptible TB and their households. The results of this feasibility study will inform the design and objectives of other larger studies on cash transfers and social support for TB patients in Viet Nam.
FIT also supports the Liverpool School of Tropical Medicine and the IMPACT-TB research team in conducting a longitudinal patient cost survey to understand patient and household costs incurred as a result of TB. The data from these surveys will be combined with health system costs to measure the impact of the intervention and to estimate the cost-effectiveness of active case finding from a health system and societal perspective.