Vietnam: Better TB Specimen Referral System Improves MDR-TB Diagnostic Accuracy and Safety

 {Photo credit: Giang Hoai Nguyen/MSH, Vietnam.}TB CARE I conducts on-site training to teach laboratory staff at Hanoi Lung Hospital how to safely package TB samples before shipping them to the national laboratory.Photo credit: Giang Hoai Nguyen/MSH, Vietnam.

Vietnam is one of 27 countries with the highest burden of multi-drug resistant tuberculosis (MDR-TB), a form of TB that is hard to treat and cannot be cured by at least two of the primary treatment drugs. Unfortunately, the country has just two national laboratories equipped for MDR-TB diagnosis.

Until recently, health facility staff had to deliver patient specimens to the laboratories themselves—often requiring laboratory technicians to travel long distances over poor roads. Samples frequently were damaged from heat or incorrect packaging and, if exposed, posed a high risk of infection to those in close proximity. The inconvenience and risks of this system deterred staff from regularly delivering patient samples to the laboratories for testing. As a result, many MDR-TB patients were unaware of their condition and unable to receive effective treatment.

In 2010, seeking to address this problem, the USAID-funded TB CARE I project and its implementer, Management Sciences for Health (MSH), developed and distributed standard operating procedures for safe packaging of specimen samples. The team then trained staff from five facilities to use these guidelines and hired a private courier company to transport the specimens to the national laboratories. To further ensure safety, TB CARE I provided secure packing materials to all five sites.

After six months pilot testing the new guidelines, packaging materials, and courier system, the total number of specimens examined at the national laboratories had increased by 27 percent (from 39,030 to 53,510) and the number of new patients beginning MDR-TB treatment had increased by 19 percent (from 578 to 713).

In addition to improved patient care, the staff is also grateful for the enhanced efficiency and safety this new delivery system offers. Dr. Hien, Head of the National K74 Hospital Laboratory, said:

"[The specimen referral system] is much more convenient now. It’s safe for our staff and environment. My staff does not need to travel to Hanoi and back by motorbike carrying samples."

Since completing the pilot, MSH has trained staff at 99 additional health facility sites to use safe packaging guidelines. The team is also establishing a delivery system through the national postal service, which will replace the more expensive private courier system.

Since 2010, KNCV has been implementing USAID’s TB CARE I project in Vietnam in partnership with MSH and the World Health Organization.