OBJECTIVES:A pooled testing algorithm for tuberculosis (TB), in which sputum specimens from multiple individuals are tested in pools with individual testing of positive pools, can optimize diagnostic resources. This study evaluated the diagnostic accuracy and cartridge savings of pooled testing with the Xpert MTB/RIF Ultra assay (Xpert-Ultra) versus individual Xpert-Ultra testing. METHODS:We conducted a cross-sectional study among 2396 adults (≥15 years) with presumptive TB enrolled between July 2024 and February 2025, through facility-based case finding (FBCF) and community-based case finding (CBCF). Participants submitted two sputum specimens. The first underwent individual Xpert-Ultra testing; remnant specimens were combined into 4-specimen pools (0.5 mL per specimen; total 2 mL) and retested using Xpert-Ultra. The second specimen was used to inoculate liquid culture (BACTEC MGIT). Data were used to simulate an upfront pooled testing strategy; sensitivity and specificity were estimated against culture, and cartridge use was compared with individual Xpert-Ultra testing. RESULTS:Of 2396 participants, 395 (16.5%) had a positive Xpert-Ultra and/or culture, including 360 of 912 (39.5%) in FBCF and 35 of 1484 (2.4%) in CBCF. The pooled testing approach had sensitivity of 82.4% (95% confidence interval [CI], 77.9-86.3) and specificity of 98.5% (97.8-99.0) compared with culture, with lower sensitivity than individual Xpert-Ultra testing (86.5%, 82.4-89.9) but high specificity (98.1%, 97.4-98.7). Sensitivity of pooled testing was lower in CBCF (59.1%, 36.4-79.3) than in FBCF (84.0%, 79.5-87), whereas cartridge savings were greater in CBCF (69.1% vs. 9.6%). The pooling strategy reduced Xpert-Ultra cartridge use by 46.5%, saving USD 14 447. CONCLUSIONS:Pooled Xpert-Ultra testing among adults appears resource-efficient for TB screening in Vietnam. As sensitivity is lower than individual Xpert-Ultra testing, particularly for paucibacillary disease, these losses should be carefully weighed against gains in affordability and expanded access to molecular testing. Careful, context-specific implementation is essential to maximize programmatic benefit while minimizing missed persons with TB.

Objectives Tuberculosis (TB) remains underdiagnosed in many high-burden countries due to high costs and limited availability of rapid molecular tests. Globally, only half of people with TB receive a molecular test as their initial diagnostic test. Pooled testing combines sputum samples from multiple individuals into a single molecular assay, offering cost savings by optimising existing resources, particularly in resource-constrained health systems. Although pooled sputum testing has now been recommended by the World Health Organization in 2026, evidence on real-world feasibility and acceptability for people with TB and healthcare providers remains limited. This study explored multisectoral stakeholder perspectives on the feasibility and acceptability of pooled sputum testing for TB. Design Multicountry qualitative study using key informant interviews and focus group discussions. Data were analysed using a framework approach guided by established feasibility and acceptability models. Setting Facility and community settings across seven high-TB-burden countries: Bangladesh, Brazil, Cameroon, Kenya, Malawi, Nigeria, and Viet Nam. Participants Thirty-eight key informant interviews and 18 focus group discussions were conducted with National TB Programme (NTP) representatives, laboratory technicians, people with TB and international experts. Results Pooled testing was considered feasible and acceptable in facility and community settings with greater confidence in countries with prior implementation experience. Feasibility depended on alignment with diagnostic algorithms and laboratory workflows, biosafety, training and clear standard operating procedures. Acceptability operated at two levels: early NTP engagement with healthcare providers to secure professional buy-in and clear communication between healthcare providers and people undergoing testing to support understanding. Conclusions Pooled testing was considered feasible and acceptable in settings with robust laboratory systems and routine practices. Readiness varied across countries, with some suitable for rapid implementation and scale-up while others required system strengthening. In settings perceived as having suitable infrastructure and readiness, pooled testing was viewed as a pragmatic strategy to optimise molecular TB testing.

Tuberculosis remains a leading public health and socioeconomic challenge in low- and middle-income countries such as Vietnam. Affected households often experience financial hardship, stigma, and psychological distress. Social protection interventions that integrate financial and psychosocial support may address these intersecting challenges. This study will evaluate the effectiveness and implementation of a psycho-socioeconomic support intervention combining conditional cash transfers with peer-led support groups (clubs) to improve tuberculosis treatment outcomes and reduce catastrophic costs. A hybrid type II effectiveness-implementation randomized controlled trial will be conducted in 12 districts across northern, central, and southern Vietnam. Adults with drug-sensitive pulmonary tuberculosis will be individually randomized 1:1 to receive standard of care or the intervention. Data will be collected at the individual, household, and club levels. The co-primary outcomes will include individual-level treatment success and household-level catastrophic cost incurrence. The primary implementation outcome will be club-level fidelity, measured through a composite adherence score. Secondary outcomes will be health-related quality of life, tuberculosis-related stigma, depression, sustainable livelihoods, uptake of tuberculosis-related healthcare services and social health insurance. A mixed-method process evaluation will assess acceptability, participation, quality, and contextual influences. Cost-effectiveness will be assessed. Developed through a people-centered design process, the intervention will target socioeconomic and psychosocial determinants of tuberculosis care. By combining cash transfers and peer support, it will seek to enhance treatment engagement, financial resilience, and equity. Findings will aim to generate actionable evidence for national scale-up in Vietnam and inform policies in other high-burden settings.

Computer-aided detection (CAD) software provides scalable, standardized chest X-ray (CXR) interpretation, helping address the global shortage of radiologists and inter-reader variability. Printed X-ray films remain common in many low-resource settings, yet most CAD software can only process Digital Imaging and Communications in Medicine (DICOM) files. Genki software (DeepTek, India) is one of the few World Health Organization (WHO)–recommended CAD software capable of interpreting both DICOM files and photographs of printed X-ray films (Joint Photographic Experts Group [JPEG] files), but its performance using JPEG files has not been independently evaluated. We evaluated Genki software using a test library of 1466 CXR images from adults screened for tuberculosis (TB) in Ho Chi Minh City, Viet Nam. Each participant’s TB status was determined using a composite reference standard, based on radiological findings and Xpert MTB/RIF Ultra testing. Each CXR image was blindly re-read by 10 human readers and processed by Genki software using both DICOM and JPEG files. Genki software performance was evaluated using median abnormality scores, area under the receiver operating characteristic curves (AUC), and sensitivity/specificity comparisons at different abnormality score thresholds. Genki software abnormality scores were significantly higher when using JPEG files, but this did not translate into significant differences in AUCs between the file types (DICOM AUC = 0.94 vs JPEG AUC = 0.92, p = 0.190). When abnormality score thresholds were calibrated to match average human reader sensitivity (79.0

Abstract Background Tuberculosis (TB) is the archetypal disease of poverty, driven by social determinants and causing catastrophic costs. A 2023 United Nations General Assembly resolution called for all TB-affected people to receive a social benefits package by 2027. Cash transfers have been shown to improve health outcomes; however, operational evidence on their implementation and effectiveness in reducing catastrophic costs due to TB is limited. This pilot study sought to assess the feasibility of delivering cash transfers to people affected by drug-susceptible TB to inform the design of a future trial. Methods A longitudinal, non-randomized cohort study was conducted in Ho Chi Minh City, Vietnam. Half of the participants received unconditional cash transfers (UCTs) while the other half received conditional cash transfers (CCTs) after monthly appointment attendance and completion of 85% of scheduled doses. We analyzed pilot data to assess rates of participant enrollment, adherence and retention in the intervention, TB treatment success, and catastrophic cost incurrence. A 22-day time and motion study quantified the distribution of time pilot staff spent administering the cash transfer intervention by cohort. Results Delivering cash transfers was feasible, with 60/70 (85.7%) and 60/66 (90.9%) of eligible individuals in the CCT and UCT cohorts agreeing to participate, respectively. Only 12.3% of CCT participants had one or more transfers withheld and 5.8% of the total expected CCTs were withheld. Delivering CCTs in the observation period took twice as much time as UCTs (32.4 hours for 43 CCT participants vs. 16.0 hours for 47 UCT participants). There were no significant differences in TB treatment success rates between the cohorts (91.7% CCT vs. 93.3% UCT). Cash transfers caused catastrophic cost incurrence to decline by 12.9% in the CCT cohort (44.2% to 38.5%) and 26.9% in the UCT cohort (26.8% to 19.6%). Conclusions Cash transfers are a feasible way to mitigate the economic burden of TB in Vietnam. The conditionality assessed was not associated with any quantifiable benefits to TB-affected people, and required more effort to implement. A larger trial utilizing similar methods and outcomes is warranted. Our findings inform the design of a slightly modified approach of cash transfer delivery for the larger trial.

New versions of computer-aided detection (CAD) software for chest X-ray (CXR) interpretation during tuberculosis (TB) screening are regularly released which purport to have incremental performance gains. No studies have independently assessed differences in software performance between the World Health Organization recommended INSIGHT CXR software (Lunit, South Korea). A well-characterized Digital Imaging and Communications in Medicine (DICOM) test library was compiled using data from a community-based TB screening initiative in Ho Chi Minh City, Viet Nam. The performance of Lunit CAD software versions 3.1.0.0 and 3.9.0.1 (newer version) were compared by measuring the area under the receiver operating characteristic curve (AUC), stratified by key clinical and demographic variables and using Xpert MTB/RIF Ultra (Ultra) test results as the reference standard. Median abnormality scores were compared using the Wilcoxon signed-rank test and performance characteristics were compared at clinically-relevant cut-off thresholds (e.g., 90% sensitivity) between the versions. The DICOM test library contained 2,708 participants, of whom 10.3% had a Mycobacterium tuberculosis (MTB) positive Ultra test result. The newer software version had a significantly higher AUC than its predecessor (AUC 0.76 vs 0.78, p = 0.029), and performed significantly better among people with a past history of TB (AUC 0.67 vs 0.73, p = 0.003), older individuals (0.75 vs 0.77, p = 0.040) and males (0.73 vs 0.76, p = 0.008). When using an cut-off threshold optimized for the older software version, the newer software was significantly less accurate than its predecessors. However, when the cut-off threshold was re-calibrated, there were no significant differences in sensitivity and specificity between the software versions. Although INSIGHT CXR v3.9.0.1 has some significantly improved performance characteristics compared to its predecessor, further studies should assess how these performance differences translate into real-world improvements during TB screening. As new CAD software versions are rolled out, cut-off thresholds must be re-calibrated to ensure the continued accuracy of CXR interpretation.

In many settings, Tuberculosis (TB) represents a catastrophic life event that substantially impairs a person’s Health-Related Quality of Life (HRQoL). We aimed to measure HRQoL among people with TB in Viet Nam at initiation and throughout treatment. This study took place in four provinces from Oct-2020 to Sep-2022. Persons initiated on TB treatment were consecutively recruited across three pathways to access care: passive case finding (NTP); active case finding (ACF); and private sector engagement (PPM). We conducted the EuroQol–5-Dimension–5-Level (EQ-5D-5L) survey during the intensive, continuation, and post-treatment phase. We described participant characteristics, assessed the survey’s psychometric properties, and calculated utility indexes using a Vietnamese value set. We reported these alongside visual analog scale (EQ-VAS) scores and EQ-5D-5L dimensions by treatment stage, care pathway and other participant characteristics. Mixed-effect Tobit models were fitted to identify relevant associations with HRQoL, which we compared to general population benchmarks. We recruited 585 participants (23.6

Abstract Background In 2022, fewer than half of persons with tuberculosis (TB) had access to molecular diagnostic tests for TB due to their high costs. Studies have found that the use of artificial intelligence (AI) software for chest X-ray (CXR) interpretation and sputum specimen pooling can each reduce the cost of testing. We modeled the combination of both strategies to estimate potential savings in consumables that could be used to expand access to molecular diagnostics. Methods We obtained Xpert testing and positivity data segmented into deciles by AI probability scores for TB from the community- and healthcare facility-based active case finding conducted in Bangladesh, Nigeria, Viet Nam, and Zambia. AI scores in the model were based on CAD4TB version 7 (Zambia) and qXR (all other countries). We modeled four ordinal screening and testing approaches involving AI-aided CXR interpretation to indicate individual and pooled testing. Setting a false negative rate of 5%, for each approach we calculated additional and cumulative savings over the baseline of universal Xpert testing, as well as the theoretical expansion in diagnostic coverage. Results In each country, the optimal screening and testing approach was to use AI to rule out testing in deciles with low AI scores and to guide pooled vs individual testing in persons with moderate and high AI scores, respectively. This approach yielded cumulative savings in Xpert tests over baseline ranging from 50.8% in Zambia to 57.5% in Nigeria and 61.5% in Bangladesh and Viet Nam. Using these savings, diagnostic coverage theoretically could be expanded by 34% to 160% across the different approaches and countries. Conclusions Using AI software data generated during CXR interpretation to inform a differentiated pooled testing strategy may optimize TB diagnostic test use, and could extend molecular tests to more people who need them. The optimal AI thresholds and pooled testing strategy varied across countries, which suggests that bespoke screening and testing approaches may be needed for differing populations and settings.

Background Vietnam's primary mechanism of achieving sustainable funding for universal health coverage (UHC) and financial protection has been through its social health insurance (SHI) scheme. Steady progress towards access has been made and by 2020, over 90% of the population were enrolled in SHI. In 2022, as part of a larger transition towards the increased domestic financing of healthcare, tuberculosis (TB) services were integrated into SHI. This change required people with TB to use SHI for treatment at district-level facilities or to pay out of pocket for services. This study was conducted in preparation for this transition. It aimed to understand more about uninsured people with TB, assess the feasibility of enrolling them into SHI, and identify the barriers they faced in this process.Methods A mixed-method case study was conducted using a convergent parallel design between November 2018 and January 2022 in ten districts of Hanoi and Ho Chi Minh City, Vietnam. Quantitative data were collected through a pilot intervention that aimed to facilitate SHI enrollment for uninsured individuals with TB. Descriptive statistics were calculated. Qualitative interviews were conducted with 34 participants, who were purposively sampled for maximum variation. Qualitative data were analyzed through an inductive approach and themes were identified through framework analysis. Quantitative and qualitative data sources were triangulated.Results We attempted to enroll 115 uninsured people with TB into SHI; 76.5% were able to enroll. On average, it took 34.5 days to obtain a SHI card and it cost USD 66 per household. The themes indicated that a lack of knowledge, high costs for annual premiums, and the household-based registration requirement were barriers to SHI enrollment. Participants indicated that alternative enrolment mechanisms and greater procedural flexibility, particularly for undocumented people, is required to achieve full population coverage with SHI in urban centers.Conclusions Significant addressable barriers to SHI enrolment for people affected by TB were identified. A quarter of individuals remained unable to enroll after receiving enhanced support due to lack of required documentation. The experience gained during this health financing transition is relevant for other middle-income countries as they address the provision of financial protection for the treatment of infectious diseases.

Abstract Background A population-wide, systematic screening initiative for tuberculosis (TB) was implemented on Daru island in the Western Province of Papua New Guinea, where TB is known to be highly prevalent. The initiative used a mobile van equipped with a digital X-ray device, computer-aided detection (CAD) software to identify TB-related abnormalities on chest radiographs, and GeneXpert machines for follow-on diagnostic testing. We describe the results of the TB screening initiative, evaluate its population-level impact and examine risk factors associated with TB detection. Methods Through a retrospective review of screening data, we assessed the effectiveness of the screening by examining the enrolment coverage and the proportion of people with TB among screened subjects. A cascade analysis was performed to illustrate the flow of participants in the screening algorithm. We conducted univariate and multivariate analyses to identify factors associated with TB. Furthermore, we estimated the number of additional cases detected by the project by examining the trend of routine TB case notifications during the intervention period, compared to the historical baseline cases and trend-adjusted expected cases. Results Of the island’s 18,854 residents, 8,085 (42.9%) were enrolled and 7,970 (98.6%) had chest X-ray interpreted by the CAD4TB software. A total of 1,116 (14.0%) participants were considered to have abnormal CXR. A total of 69 Xpert-positive cases were diagnosed, resulting in a detection rate of 853 per 100 000 population screened. 19.4% of people with TB had resistance to rifampicin. People who were in older age groups (aOR 6.6, 95%CI: 1.5–29.1 for the 45–59 age group), were severely underweight (aOR 2.5, 95%CI:1.0-6.1) or underweight (aOR 2.1, 95%CI: 1.1–3.8), lived in households < 5 people (aOR 3.4, 95%CI:1.8–6.6) and had a past history of TB (aOR 2.1, 95%CI: 1.2–3.6) were more likely to have TB. The number of bacteriologically confirmed TB notified during the intervention period was 79.3% and 90.8% higher than baseline notifications and forecasted notifications, respectively. Conclusion The screening project demonstrated its effectiveness with the high Xpert-positive TB prevalence among the participants and by successfully yielding additional cases of bacteriologically confirmed TB including rifampicin-resistant TB. The results and lessons learnt from the project should inform future TB screening initiatives in Papua New Guinea.

INTRODUCTION:The large reservoir of tuberculosis (TB) infections is one of the main reasons for the persistent incidence of TB. Accurate diagnostic tests are crucial to correctly identify and treat people with TB infection, which is vital to eliminate TB globally. The rdESAT-6 and rCFP-10 (Cy-Tb) injection ('Cy-Tb'), a TB-specific antigen skin test and STANDARD F TB-Feron FIA ('Standard F TB') measuring interferon-gamma by fluorescence immunoassay assay are two novel tools for the diagnosis of TB infection which offer advantages compared with current tests in low-resource settings and reduced costs to both health systems and TB-affected people. The proposed study aims to evaluate the diagnostic accuracy of these two new tests for TB infection diagnosis. METHODS AND ANALYSIS:This cross-sectional study aims to assess the diagnostic accuracy for TB infection of the Cy-Tb skin test and Standard F TB assay (investigational tests) compared with the QuantiFERON-TB Gold Plus (QFT-Plus) assay as the immunological reference standard. Three different cohorts of study participants will be recruited at the Vietnam National Lung Hospital: adults with bacteriologically confirmed pulmonary TB (n=100), household contacts of people with TB (n=200) and people without TB infection (n=50). All consenting participants will undergo simultaneous testing with Cy-Tb, Standard F TB and QFT-Plus. The primary endpoint is the diagnostic accuracy of the Cy-Tb skin test and Standard F TB assay, expressed as sensitivity and specificity against the reference standard. ETHICS AND DISSEMINATION:Ethical approval was granted by the Vietnam National Lung Hospital Institutional Review Board (65/23/CN-HDDD-BVPTU) and the Swedish Ethical Review Authority (Dnr 2023-04271-01). Study results will be disseminated to the scientific community and policymakers through scientific publications. TRIAL REGISTRATION NUMBER:NCT06221735.

COVID-19 significantly disrupted tuberculosis (TB) services in Vietnam. In response, the National TB Program (NTP) integrated TB screening using mobile chest X-rays into COVID-19 vaccination events. This prospective cohort study evaluated the integrated model’s yield, treatment outcomes, and costs. We further fitted regressions to identify risk factors and conduct interrupted time-series analyses in the study area, Vietnam’s eight economic regions, and at the national level. At 115 events, we conducted 48,758 X-ray screens and detected 174 individuals with TB. We linked 89.7% to care, while 92.9% successfully completed treatment. The mean costs per person diagnosed with TB was $547. TB risk factors included male sex (aOR = 6.44, p < 0.001), age of 45–59 years (aOR = 1.81, p = 0.006) and ≥60 years (aOR = 1.99, p = 0.002), a history of TB (aOR = 7.96, p < 0.001), prior exposure to TB (aOR = 3.90, p = 0.001), and symptomatic presentation (aOR = 2.75, p < 0.001). There was a significant decline in TB notifications during the Delta wave and significant increases immediately after lockdowns were lifted (IRR(γ1) = 5.00; 95%CI: (2.86, 8.73); p < 0.001) with a continuous upward trend thereafter (IRR(γ2) = 1.39; 95%CI: (1.22, 1.38); p < 0.001). Similar patterns were observed at the national level and in all regions but the northeast region. The NTP’s swift actions and policy decisions ensured continuity of care and led to the rapid recovery of TB notifications, which may serve as blueprint for future pandemics.

Current strategies to promptly, effectively, and equitably screen people with tuberculosis (TB) and link them to diagnosis and care are insufficient; new approaches are required to find the millions of people around the world with TB who are missed each year. Interventions also need to be designed considering how people interact with health care facilities and where appropriate should be suitable for use in the community. Here, the historical, new, and reemerging technologies that are being utilised for TB diagnosis globally are discussed, whilst highlighting that how we use and evaluate tests is just as important as the tests themselves.

Background In Viet Nam, tuberculosis (TB) represents a devastating life-event with an exorbitant price tag, partly due to lost income from daily directly observed therapy in public sector care. Thus, persons with TB may seek care in the private sector for its flexibility, convenience, and privacy. Our study aimed to measure income changes, costs and catastrophic cost incurrence among TB-affected households in the public and private sector. Methods Between October 2020 and March 2022, we conducted 110 longitudinal patient cost interviews, among 50 patients privately treated for TB and 60 TB patients treated by the National TB Program (NTP) in Ha Noi, Hai Phong and Ho Chi Minh City, Viet Nam. Using a local adaptation of the WHO TB patient cost survey tool, participants were interviewed during the intensive phase, continuation phase and post-treatment. We compared income levels, direct and indirect treatment costs, catastrophic costs using Wilcoxon rank-sum and chi-squared tests and associated risk factors between the two cohorts using multivariate regression. Results The pre-treatment median monthly household income was significantly higher in the private sector versus NTP cohort (USD 868 vs USD 578; P = 0.010). However, private sector treatment was also significantly costlier (USD 2075 vs USD 1313; P = 0.005), driven by direct medical costs which were 4.6 times higher than costs reported by NTP participants (USD 754 vs USD 164; P < 0.001). This resulted in no significant difference in catastrophic costs between the two cohorts (Private: 55% vs NTP: 52%; P = 0.675). Factors associated with catastrophic cost included being a single-person household [adjusted odds ratio (a OR = 13.71; 95% confidence interval ( CI) : 1.36–138.14; P = 0.026], unemployment during treatment (a OR = 10.86; 95% CI : 2.64–44.60; P < 0.001) and experiencing TB-related stigma (a OR = 37.90; 95% CI : 1.72–831.73; P = 0.021). Conclusions Persons with TB in Viet Nam face similarly high risk of catastrophic costs whether treated in the public or private sector. Patient costs could be reduced through expanded insurance reimbursement to minimize direct medical costs in the private sector, use of remote monitoring and multi-week/month dosing strategies to avert economic costs in the public sector and greater access to social protection mechanism in general.

Introduction The health and economic burden of tuberculosis (TB) in urban Viet Nam is high. Social protection and support interventions can improve treatment outcomes and reduce costs. However, evidence regarding optimal strategies in this context is lacking. This study aimed to increase understanding of what people with TB and healthcare providers (HCPs) perceive as important to improve TB treatment outcomes and reduce costs.Methods We conducted qualitative focus group discussions (seven groups, n=30) and key informant interviews (n=4) with people with drug-susceptible and multidrug-resistant TB and HCPs in Ha Noi and Ho Chi Minh City. Topic guides covered perspectives on and prioritisation of different forms of social protection and support. Data were analysed using reflexive thematic analysis and interpreted using a Framework for Transformative Social Protection.Results We identified three themes and seven subthemes. The first theme, ‘Existing financial safety nets are essential, but could go further to support people affected by TB’, highlights that support to meet the medical costs of TB treatment and flexible cash transfers are a priority for people with TB and HCPs. The second, ‘It is important to promote “physical and spiritual health” during TB treatment’, demonstrates that extended psychosocial and nutritional support would encourage people with TB during their treatment. The third, ‘Accessibility and acceptability are critical in designing social support interventions for people with TB’, shows the importance of ensuring that support is accessible and proportional to the needs of people with TB and their families.Conclusions Accessible interventions that incorporate financial risk protection, nutritional and psychosocial support matter most to people with TB and HCPs in urban Viet Nam to improve their treatment outcomes and reduce catastrophic costs. This study can inform the design of stronger person-centred interventions to advance progress towards the goals of the WHO’s End TB Strategy.

Current WHO-recommended diagnostic tools for tuberculosis infection (TBI) have well-known limitations and viable alternatives are urgently needed. We compared the diagnostic performance and accuracy of the novel QIAreach QuantiFERON-TB assay (QIAreach; index) to the QuantiFERON-TB Gold Plus assay (QFT-Plus; reference). The sample included 261 adults (≥ 18 years) recruited at community-based TB case finding events. Of these, 226 underwent Tuberculin Skin Tests and 200 returned for interpretation (TST; comparator). QIAreach processing and TST reading were completed at lower-level healthcare facilities. We conducted matched-pair comparisons for QIAreach and TST with QFT-Plus, calculated sensitivity, specificity and area under a receiver-operating characteristic curve (AUC), and analyzed concordant-/discordant-pair interferon-gamma (IFN-γ) levels. QIAreach sensitivity and specificity were 98.5% and 72.3%, respectively, for an AUC of 0.85. TST sensitivity (53.2%) at a 5 mm induration threshold was significantly below QIAreach, while specificity (82.4%) was statistically equivalent. The corrected mean IFN-γ level of 0.08 IU/ml and corresponding empirical threshold (0.05) of false-positive QIAreach results were significantly lower than the manufacturer-recommended QFT-Plus threshold (≥ 0.35 IU/ml). Despite QIAreach's higher sensitivity at equivalent specificity to TST, the high number of false positive results and low specificity limit its utility and highlight the continued need to expand the diagnostic toolkit for TBI.

Background There is extensive evidence for the cost-effectiveness of programmatic and additional tuberculosis (TB) interventions, but no studies have employed the social return on investment (SROI) methodology. We conducted a SROI analysis to measure the benefits of a community health worker (CHW) model for active TB case finding and patient-centered care. Methods This mixed-method study took place alongside a TB intervention implemented in Ho Chi Minh City, Viet Nam, between October-2017 – September-2019. The valuation encompassed beneficiary, health system and societal perspectives over a 5-year time-horizon. We conducted a rapid literature review, two focus group discussions and 14 in-depth interviews to identify and validate pertinent stakeholders and material value drivers. We compiled quantitative data from the TB program’s and the intervention’s surveillance systems, ecological databases, scientific publications, project accounts and 11 beneficiary surveys. We mapped, quantified and monetized value drivers to derive a crude financial benefit, which was adjusted for four counterfactuals. We calculated a SROI based on the net present value (NPV) of benefits and investments using a discounted cash flow model with a discount rate of 3.5%. A scenario analysis assessed SROI at varying discount rates of 0-10%. Results The mathematical model yielded NPVs of US$235,511 in investments and US$8,497,183 in benefits. This suggested a return of US$36.08 for each dollar invested, ranging from US$31.66-US39.00 for varying discount rate scenarios. Conclusions The evaluated CHW-based TB intervention generated substantial individual and societal benefits. The SROI methodology may be an alternative for the economic evaluation of healthcare interventions.

BackgroundRecent technological and radiological advances have renewed interest in using X-rays to screen and triage people with tuberculosis (TB). The miniaturization of digital X-ray (DXR), combined with automatic interpretation using computer-aided detection (CAD) software can extend the reach of DXR screening interventions for TB. This qualitative study assessed early implementers' experiences and lessons learned when using ultra-portable (UP) DXR systems integrated with CAD software to screen and triage TB.MethodsSemi-structured interviews were conducted with project staff and healthcare workers at six pilot sites. Transcripts were coded and analyzed using a framework approach. The themes that emerged were subsequently organized and presented using the Consolidated Framework for Implementation Research (CFIR).ResultsThere were 26 interviewees with varying roles: supervisory, clinicians, radiographers, and radiologists. Participants recognized the portability as the main advantage, but criticize that it involves several compromises on throughput, internet dependence, manoeuvrability, and stability, as well as suitability for patients with larger body sizes. Furthermore, compared to using hardware and software from the same supplier and without digital health information systems, complexity increases with interoperability between hardware and software, and between different electronic health information systems. Currently, there is a limited capacity to implement these technologies, especially due to the need for threshold selection, and lack of guidance on radiation protection suitable for UP DXR machines. Finally, the respondents stressed the importance of having protected means of sharing patient medical data, as well as comprehensive support and warranty plans.ConclusionStudy findings suggest that UP DXR with CAD was overall well received to decentralize radiological assessment for TB, however, the improved portability involved programmatic compromises. The main barriers to uptake included insufficient capacity and lack of guidance on radiation protection suitable for UP DXR.

Background Globally, most people with multidrug-resistant tuberculosis (MDR-TB) and their households experience catastrophic costs of illness, diagnosis, and care. However, the factors associated with experiencing catastrophic costs are poorly understood. This study aimed to identify risk factors associated with catastrophic costs incurrence among MDR-TB-affected households in Ho Chi Minh City (HCMC), Viet Nam. Methods Between October 2020 and April 2022, data were collected using a locally-adapted, longitudinal WHO TB Patient Cost Survey in ten districts of HCMC. Ninety-four people with MDR-TB being treated with a nine-month TB regimen were surveyed at three time points: after two weeks of treatment initiation, completion of the intensive phase and the end of the treatment (approximately five and 10 months post-treatment initiation respectively). The catastrophic costs threshold was defined as total TB-related costs exceeding 20% of annual pre-TB household income. Logistic regression was used to identify variables associated with experiencing catastrophic costs. A sensitivity analysis examined the prevalence of catastrophic costs using alternative thresholds and cost estimation approaches. Results Most participants (81/93 [87%]) experienced catastrophic costs despite the majority 86/93 (93%) receiving economic support through existing social protection schemes. Among participant households experiencing and not experiencing catastrophic costs, median household income was similar before MDR-TB treatment. However, by the end of MDR-TB treatment, median household income was lower (258 [IQR: 0–516] USD vs. 656 [IQR: 462–989] USD; p = 0.003), and median income loss was higher (2838 [IQR: 1548–5418] USD vs. 301 [IQR: 0–824] USD; p < 0.001) amongst the participant households who experienced catastrophic costs. Being the household’s primary income earner before MDR-TB treatment (aOR = 11.2 [95% CI: 1.6–80.5]), having a lower educational level (aOR = 22.3 [95% CI: 1.5–344.1]) and becoming unemployed at the beginning of MDR-TB treatment (aOR = 35.6 [95% CI: 2.7–470.3]) were associated with experiencing catastrophic costs. Conclusion Despite good social protection coverage, most people with MDR-TB in HCMC experienced catastrophic costs. Incurrence of catastrophic costs was independently associated with being the household’s primary income earner or being unemployed. Revision and expansion of strategies to mitigate TB-related catastrophic costs, in particular avoiding unemployment and income loss, are urgently required.

Objectives To end tuberculosis (TB), the vast reservoir of 1.7–2.3 billion TB infections (TBIs) must be addressed, but achieving global TB preventive therapy (TPT) targets seems unlikely. This study assessed the feasibility of using interferon-γ release assays (IGRAs) at lower healthcare levels and the comparative performance of 3-month and 9-month daily TPT regimens (3HR/9H).Design, setting, participants and intervention This cohort study was implemented in two provinces of Viet Nam from May 2019 to September 2020. Participants included household contacts (HHCs), vulnerable community members and healthcare workers (HCWs) recruited at community-based TB screening events or HHC investigations at primary care centres, who were followed up throughout TPT.Primary and secondary outcomes We constructed TBI care cascades describing indeterminate and positivity rates to assess feasibility, and initiation and completion rates to assess performance. We fitted mixed-effects logistic and stratified Cox models to identify factors associated with IGRA positivity and loss to follow-up (LTFU).Results Among 5837 participants, the indeterminate rate was 0.8%, and 30.7% were IGRA positive. TPT initiation and completion rates were 63.3% (3HR=61.2% vs 9H=63.6%; p=0.147) and 80.6% (3HR=85.7% vs 9H=80.0%; p=0.522), respectively. Being male (adjusted OR=1.51; 95% CI: 1.28 to 1.78; p<0.001), aged 45–59 years (1.30; 1.05 to 1.60; p=0.018) and exhibiting TB-related abnormalities on X-ray (2.23; 1.38 to 3.61; p=0.001) were associated with positive IGRA results. Risk of IGRA positivity was lower in periurban districts (0.55; 0.36 to 0.85; p=0.007), aged <15 years (0.18; 0.13 to 0.26; p<0.001), aged 15–29 years (0.56; 0.42 to 0.75; p<0.001) and HCWs (0.34; 0.24 to 0.48; p<0.001). The 3HR regimen (adjusted HR=3.83; 1.49 to 9.84; p=0.005) and HCWs (1.38; 1.25 to 1.53; p<0.001) showed higher hazards of LTFU.Conclusion Providing IGRAs at lower healthcare levels is feasible and along with shorter regimens may expand access and uptake towards meeting TPT targets, but scale-up may require complementary advocacy and education for beneficiaries and providers.