The project evaluating the effectiveness and safety of a model for universal diagnosis and treatment of latent tuberculosis combined with proactive detection of tuberculosis cases in reducing the incidence of tuberculosis in the community (ACT5 Project) has been implemented in Ca Mau province since April 2022. The project is supported by the National Lung Hospital and the Woolcock Institute of Medical Research, and will be implemented in Ca Mau province from 2022 to 2026. Specifically, during the period from 2024 to 2025, it is expected that approximately 156,000 people in 9 districts and cities with 208 hamlets and villages will continue to be screened for tuberculosis, along with the implementation of screening for other non-communicable diseases.

In Ca Mau City, across 17 hamlets/villages participating in the intervention, the ACT5 Project screened 15,003 participants aged 5 and above for latent tuberculosis using the Tuberculin Skin Testing (TST) method. 98.6% of participants agreed to participate, while the remaining 1.4% did not receive the injection after signing the consent form. After the TST injection, project staff continued to visit participants within 48-96 hours to measure the test results. 14,379 participants completed the TST reading, representing 95.8% of those vaccinated, with a TST positive rate of approximately 36.2%. Of these, the positive rate was approximately 36% in adults and 16% in children. Based on the treatment completion rate among the total number of people starting treatment in Ca Mau City, it can be seen that the level of adherence to treatment completion among the population is generally stable at approximately 50% or higher, although the rate of starting treatment is not yet high; this rate is also similar to some urban areas/towns throughout the province. Three out of 17 hamlets/villages have a treatment completion rate below 50%, which can be partly explained by the specific characteristics of each area.

Each person had their blood pressure measured three times to further screen for other non-communicable diseases.

Each person had their blood pressure measured three times to further screen for other non-communicable diseases.

Currently, under the National Tuberculosis Control Program, screening and treatment for tuberculosis are carried out on high-risk groups, meaning those who have frequent contact with tuberculosis patients or those with weakened immune systems such as HIV or hepatitis B must undergo screening. In the universal screening model, however, everyone is assessed as at risk, given our country's high tuberculosis prevalence. Healthcare workers must go door-to-door to conduct screening. After universal screening, healthcare workers continue to assess the tuberculosis prevalence between areas where screening was conducted and areas where it was not to see if the prevalence has decreased. The goal of Project ACT5 is to develop a standard model for universal screening to provide recommendations to the World Health Organization and the National Tuberculosis Control Program for application in areas with a high burden of tuberculosis.

Ms. Luu Boi Khanh, Master of Community Medicine and manager of the ACT5 Project, stated: “Currently, one of the things that the ACT5 Project is seeing is that the tuberculosis incidence rate in Ca Mau is now higher than it was 10 years ago when we were working on the ACT3 Project. Almost all screening and treatment activities have been significantly affected.”

Medical staff from the ACT5 Project are taking blood samples for testing.

Medical staff from the ACT5 Project are taking blood samples for testing.

The increase in tuberculosis infection rates in Ca Mau compared to 10 years ago is due to the use of more advanced testing methods. The sensitivity and ability of current tests to detect bacteria are superior, allowing for the detection of more newly diagnosed cases, or cases with mild symptoms and low bacterial counts. Furthermore, the COVID-19 outbreak in Vietnam in 2020 was a setback for the tuberculosis control program, as all programs were disrupted, and testing kits were either unavailable or in short supply. People were quarantined, limiting their access to healthcare facilities for medication. Other difficulties also hindered people from proactively seeking medical attention.

Ms. Luu Boi Khanh further stated that the direct investment cost in Ca Mau is over 85 billion VND from the project. Screening activities focus on X-ray imaging using mobile X-ray equipment, employing AI to detect early abnormalities in chest X-rays... For suspected tuberculosis cases, an additional Xpert test, which has very high sensitivity and reliability, will be performed for tuberculosis diagnosis.

In the 2025-2027 phase, the project will continue with an assessment of non-communicable diseases (NCDs) in the community, focusing on three main groups: hypertension, diabetes, and obstructive pulmonary disease (COPD). For hypertension, the project will follow the Ministry of Health 's guidelines, measuring blood pressure three times to determine if individuals have hypertension, in order to guide the local NCD program. For diabetes, the project will use on-site HbA1c testing and provide immediate results to participants. For COPD, the project will conduct home visits or invite residents to the most convenient location for respiratory monitoring. Simultaneously, the project will also conduct interviews on smoking habits to determine the prevalence of smoking in the community and assess their willingness to quit, in order to develop appropriate strategies for smoking control in the community.

Height and weight measurements were taken meticulously.

Height and weight measurements were taken meticulously.

Mr. PVT, born in 1967, residing in Hamlet 3, Cai Nuoc town, Cai Nuoc district, said: "Hearing the announcement about free tuberculosis screening, I tried to go. I'm concerned about my own health and also afraid of infecting those around me. I invited some neighbors, but they declined because they were busy working. Tuberculosis is easily transmitted, so everyone who has the means and can get tested for free should go."

Luu Tuong My, born in 2007, residing in Hamlet 3, Cai Nuoc town, shared: "I think young people should get tested for tuberculosis early. Currently, many young people smoke cigarettes and e-cigarettes, so the rate of tuberculosis is high. Tuberculosis testing, besides early detection and treatment if infected, also protects the community because the transmission cycle is very wide and fast."

Ms. Luu Boi Khanh stated that tuberculosis treatment is long-term, with a 6-month regimen. For tuberculosis patients, after about 1-2 weeks of taking medication, symptoms gradually decrease, and by the second month, symptoms are almost completely gone.

"However, if patients don't take their medication as prescribed, the bacteria in their bodies will multiply. Initially, nothing will happen when patients stop treatment. Over time, due to incomplete treatment, tuberculosis will relapse. Patients who don't experience symptoms, can eat and drink normally, don't cough, and don't lose weight may think treatment is unnecessary. More dangerously, at this point, if the patient gets a sputum test, the sample will be negative. From there, they become complacent and don't feel the need to continue treatment or complete the regimen," warned Ms. Luu Boi Khanh.

Lam Khanh

Source: https://baocamau.vn/sang-loc-lao-trong-cong-dong-a39194.html