RT Journal Article
SR Electronic
T1 Standardised patient study to assess tuberculosis case detection within the private pharmacy sector in Vietnam
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e006475
DO 10.1136/bmjgh-2021-006475
VO 6
IS 10
A1 Shukry Zawahir
A1 Hien Le
A1 Thu Anh Nguyen
A1 Justin Beardsley
A1 Anh Dang Duc
A1 Sarah Bernays
A1 Kerri Viney
A1 Thai Cao Hung
A1 Shannon McKinn
A1 Hoang Huy Tran
A1 Son Nguyen Tu
A1 Kavindhran Velen
A1 Tan Luong Minh
A1 Hung Tran Thi Mai
A1 Nhung Nguyen Viet
A1 Ha Nguyen Viet
A1 Van Nguyen Thi Cam
A1 Thanh Nguyen Trung
A1 Stephen Jan
A1 Ben J Marais
A1 Joel Negin
A1 Guy B Marks
A1 Gregory Fox
YR 2021
UL http://gh.bmj.com/content/6/10/e006475.abstract
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.