PT - JOURNAL ARTICLE AU - Shukry Zawahir AU - Hien Le AU - Thu Anh Nguyen AU - Justin Beardsley AU - Anh Dang Duc AU - Sarah Bernays AU - Kerri Viney AU - Thai Cao Hung AU - Shannon McKinn AU - Hoang Huy Tran AU - Son Nguyen Tu AU - Kavindhran Velen AU - Tan Luong Minh AU - Hung Tran Thi Mai AU - Nhung Nguyen Viet AU - Ha Nguyen Viet AU - Van Nguyen Thi Cam AU - Thanh Nguyen Trung AU - Stephen Jan AU - Ben J Marais AU - Joel Negin AU - Guy B Marks AU - Gregory Fox TI - Standardised patient study to assess tuberculosis case detection within the private pharmacy sector in Vietnam AID - 10.1136/bmjgh-2021-006475 DP - 2021 Oct 01 TA - BMJ Global Health PG - e006475 VI - 6 IP - 10 4099 - http://gh.bmj.com/content/6/10/e006475.short 4100 - http://gh.bmj.com/content/6/10/e006475.full SO - BMJ Global Health2021 Oct 01; 6 AB - Background Of the estimated 10 million people affected by (TB) each year, one-third are never diagnosed. Delayed case detection within the private healthcare sector has been identified as a particular problem in some settings, leading to considerable morbidity, mortality and community transmission. Using unannounced standardised patient (SP) visits to the pharmacies, we aimed to evaluate the performance of private pharmacies in the detection and treatment of TB.Methods A cross-sectional study was undertaken at randomly selected private pharmacies within 40 districts of Vietnam. Trained actors implemented two standardised clinical scenarios of presumptive TB and presumptive multidrug-resistant TB (MDR-TB). Outcomes were the proportion of SPs referred for medical assessment and the proportion inappropriately receiving broad-spectrum antibiotics. Logistic regression evaluated predictors of SPs’ referral.Results In total, 638 SP encounters were conducted, of which only 155 (24.3%) were referred for medical assessment; 511 (80·1%) were inappropriately offered antibiotics. A higher proportion of SPs were referred without having been given antibiotics if they had presumptive MDR-TB (68/320, 21.3%) versus presumptive TB (17/318, 5.3%; adjusted OR=4.8, 95% CI 2.9 to 7.8). Pharmacies offered antibiotics without a prescription to 89.9% of SPs with presumptive TB and 70.3% with presumptive MDR-TB, with no clear follow-up plan.Conclusions Few SPs with presumptive TB were appropriately referred for medical assessment by private pharmacies. Interventions to improve appropriate TB referral within the private pharmacy sector are urgently required to reduce the number of undiagnosed TB cases in Vietnam and similar high-prevalence settings.All data relevant to the study are included in the article or uploaded as supplementary information. All deidentified data are included in the article and tables.