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Table 4 Obstacles to enrolling MDR-TB patients for treatment and solutions for an effective PMDT

From: Challenges in detection and treatment of multidrug resistant tuberculosis patients in Vietnam

Ser. No Obstacle Proposed solution
1 A set of key documents is lacking: updated guidelines, concise and clear SOPs, and standard training modules. The NTP is strongly recommended to ensure that key documents are prepared and circulated to appropriate staff, with proper training. Letters with updates should be discouraged, unless there is an urgency.
2 Failures in identifying presumptive MDR-TB cases for screening. The development of consistent training modules in accordance with national guidelines and SOPs.
3 Absence of a sound referral system for sending sputum samples to a laboratory. A sound national referral system should be set up with a shipping agency who can do this safely.
4 Current Vietnam policy is to require patient to be hospitalized at the start of treatment. However, there is insufficient hospitalization capacity and patients may refuse to be referred to another treatment centre in another province either due to distance from hometown or additional costs without getting health insurance reimbursement. The NTP policy needs consider the adoption for ambulatory treatment with community based care as also recommended by WHO [3]. Health insurance need to support MDR-TB patients in reimbursing costs in case there is a need for referral to another province for PMDT treatment.
5 Temporary MDR-TB drug stock-out due to procurement and distribution delay resulted in patients either not enrolled for treatment or a delay in treatment. Improve drug procurement and distribution system.
6 TB units in many districts remain located in health centers that focus on prevention, and are separate from the general hospitals, which is discrepant from MoH policy. Enforce policy to locate TB units in the district general hospitals. Training should be provided to appropriate staff.
7 Poor links between the NTP and public sector and no management system for MDR-TB patients in prison. There is no mechanism to refer MDR-TB presumptives or MDR-TB patients from the private sector to the NTP to be diagnosed or for treatment. The private sectors often do not notify MDR-TB cases to the NTP. Establish the collaboration between the private sector and PMDT. Ensure private sector adheres to treatment guidelines for TB and MDR-TB. Provide diagnosis and treatment service for MDR-TB patients in prison.