When COVID-19 cases were rising in Viet Nam in 2021, Dr. Vu Quoc Tan also became increasingly concerned when fewer people were seeking consultation for tuberculosis (TB) in his community in Ba Dinh, a district in Hanoi.
Dr Tan has been overseeing the TB Program at the Ba Dinh Medical Center - Tuberculosis and Lung Disease Clinic for 23 years. Before 2021, he used to see 120 to 150 persons seeking TB care annually. Last year, only around 100 came to the TB clinic.
Fewer consultations meant the possibility of undetected active TB cases in his community. Furthermore, with lesser people accessing health services, compliance with TB drug treatment posed a challenge.
“If drug dispensing is interrupted, patients are also at risk of developing drug resistance. Therefore, the treatment process must be continuous, without interruption,” said Dr Tan.
Dr. Vu Quoc Tan has been overseeing the Ba Dinh Medical Center - Tuberculosis and Lung Disease Clinic in Hanoi, Viet Nam, for the last 23 years. Photo: © WHO Viet Nam/M Pham
For decades, Viet Nam has been working towards addressing the burden of TB. In 2019, around 105,000 new TB patients were detected and treated.
Viet Nam, however, has remained among the 30 countries with the highest burden of TB globally. The pandemic has threatened to stall and set back the country’s progress in TB control.
Challenges in TB control during the pandemic
In the third quarter of 2021, the Delta variant fuelled a steep rise in COVID-19 cases in Viet Nam, with the highest number of cases detected in urban areas such as Hanoi.
To help curb COVID-19 spread in the city, the Government closed most of the city roads and all public transport. Travel within the city and to other places was restricted.
While going to health facilities for medical care - including TB detection and treatment - was allowed as essential travel, many still opted to stay at home. On some occasions, persons seeking TB care in Dr Tan’s community also had to be under quarantine or isolation.
“We had fewer patients because they can’t go or didn’t feel it’s necessary. A couple of years ago, when people experienced TB symptoms, they would go immediately to the doctor,” Dr Tan said.
Dr Tan also shared that they had fewer available health workers to provide TB services.
“We were always on the go,” Dr Tan said. Health workers, especially those at the local health stations, were always dispatched to respond to the pandemic, give vaccinations or administer COVID-19 testing.
Improving access to TB care amid the pandemic
Despite many limitations due to the pandemic, Dr Tan sought to maintain access to TB screening and care in Ba Dinh District.
He tapped community health groups and volunteers and engaged them as critical links of patients to TB treatment.
“We recorded the patients’ phone numbers so we can call and urge them to come on schedule for their treatment. In some cases, we will call the patient and deliver the medicine through volunteers or family members,” said Dr Tan.
The Hanoi TB Program also held TB screening through mobile clinics, alongside COVID-19 vaccination activities.
Le Trong Hiep, a footwear vendor at the Nghia Tan Market in Ba Dinh District, is one of those who benefited from the integration of health services. Hiep screened for TB after receiving his second dose of the COVID-19 vaccine.
After receiving his positive result, Hiep sought treatment at Dr Tan’s clinic. For Hiep, compliance to TB’s six-month treatment was convenient despite the travel restrictions. The anti-TB drugs were accessible to him at a nearby local health station.
“The health workers distributed medicines to the ward, and then I would come to get them, so it was less difficult. I see that health workers here are very dedicated and enthusiastic,” said Hiep.
Dr Tan at work at the Ba Dinh Medical Center - Tuberculosis and Lung Disease Clinic in Hanoi, Viet Nam, for the last 23 years. Photo: © WHO Viet Nam/M Pham
With the additional efforts in TB control during the pandemic, Dr Tan admitted that it had been a struggle for the past two years.
“The situation is very difficult, not just for Ba Dinh but [for the country] in general,” said Dr Tan.
Asked what are on his wish list for TB care in his community, Dr Tan mentioned three things: a stable supply of anti-TB drugs, other medicines to support his patients during TB treatment and other forms of support to help the community have better access to treatment.
Refocusing on the goal to end TB
Viet Nam’s TB control program managed to stay on track in the first year of the pandemic. However, in 2021, Viet Nam had a sharp decrease in newly detected TB cases. The number went down to around 75,000, a 25% decrease compared with the previous year.
Globally, there was also a significant drop in the number of newly diagnosed with TB, from 7.1 million in 2019 to 5.8 million in 2020.
These setbacks endanger prospects of meeting global targets to end TB by 2030.
WHO calls for urgent investment to catch up on TB care, continue the fight against the deadly disease, and end TB in Viet Nam and globally.
“WHO urges every one of us – the government, health sector, relevant departments, the National TB Program, and partners to ramp up our collaborative efforts to urgently restore active case finding and enhance Find.Treat.All and maintain essential TB services. Now is the time to step up investments to end TB and save lives in Viet Nam and the rest of the world,” said Dr Kidong Park, WHO Representative in Viet Nam.
“Amid the challenges in the sustained management of COVID-19, we firmly believe that Viet Nam will be back on track and successful in ending this deadly disease,” Dr Park added.
A renewed commitment to end TB
In Viet Nam, the National TB Program is rallying various sectors to invest in ending TB.
"The COVID-19 pandemic has pushed back a few years of our progress towards ending TB in 2030. To close the gap, various resources have been raised through government's committed leadership, efforts of grassroots health services and international support, to ensure that people in the communities receive timely TB screening and care," said Associate Professor Luong Ngoc Khue, Director of the Administration of Medical Service, Ministry of Health in Viet Nam.
Getting back on track for TB control will ultimately benefit community members like Hiep, who look forward to being cured of the disease.
“Fortunately, I was screened early; otherwise, my lungs would probably be destroyed. The COVID-19 pandemic is also very dangerous for me as I have an underlying disease. I hope to be healthy so I can already work,” Hiep said.
Dr Tan remains hopeful for TB control in Viet Nam. “Compared to 2021, more people are now having their lungs checked for post-COVID check-up. We also have detected new TB cases from the test results,” Dr Tan said.
“I think everything can go back to normal,” he added.
Dr Tan with his team from the Ba Dinh Medical Center - Tuberculosis and Lung Disease Clinic. Photo: © WHO Viet Nam/M Pham