Standardised patient study to assess tuberculosis case detection within the private pharmacy sector in Vietnam

Shukry Zawahir; Hien Le; Thu Anh Nguyen; Justin Beardsley; Anh Dang Duc; Sarah Bernays; Kerri Viney; Thai Cao Hung; Shannon McKinn; Hoang Huy Tran; Son Nguyen Tu; Kavindhran Velen; Tan Luong Minh; Hung Tran Thi Mai; Nhung Nguyen Viet; Ha Nguyen Viet; Van Nguyen Thi Cam; Thanh Nguyen Trung; Stephen Jan; Ben J Marais; Joel Negin; Guy B Marks; Gregory Fox

doi:10.1136/bmjgh-2021-006475

Standardised patient study to assess tuberculosis case detection within the private pharmacy sector in Vietnam

BMJ Glob Health. 2021 Oct;6(10):e006475. doi: 10.1136/bmjgh-2021-006475.

Authors

Shukry Zawahir¹, Hien Le², Thu Anh Nguyen², Justin Beardsley³, Anh Dang Duc⁴, Sarah Bernays^{5

6}, Kerri Viney^{7

8}, Thai Cao Hung⁹, Shannon McKinn⁵, Hoang Huy Tran⁴, Son Nguyen Tu¹⁰, Kavindhran Velen⁵, Tan Luong Minh⁴, Hung Tran Thi Mai⁴, Nhung Nguyen Viet¹¹, Ha Nguyen Viet², Van Nguyen Thi Cam², Thanh Nguyen Trung², Stephen Jan¹², Ben J Marais¹³, Joel Negin¹⁴, Guy B Marks^{15

16}, Gregory Fox⁵

Affiliations

¹ Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia shukry2010@gmail.com.
² Woolcock Institute of Medical Research, Kim Ma, Hanoi, Vietnam.
³ The Marie Bashir Institute, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia.
⁴ National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
⁵ Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁶ Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
⁷ Centre of Global Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
⁸ Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
⁹ Medical Service Administration, Government of Viet Nam Ministry of Health, Hanoi, Vietnam.
¹⁰ Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.
¹¹ National TB Program, Vietnam National Lung Hospital, Hanoi, Vietnam.
¹² The George Institute for Global Health, Newtown, New South Wales, Australia.
¹³ Marie Bashir Institute for Infectious Diseases and Biosecurity and the Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
¹⁴ Faculty of Medicne and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia.
¹⁵ South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
¹⁶ Woolcock Institute of Medical Research, Glebe, New South Wales, Australia.

Abstract

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.

Keywords: health services research; other study design; public health; tuberculosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Humans
Pharmacies*
Pharmacy*
Tuberculosis* / diagnosis
Tuberculosis* / drug therapy
Tuberculosis* / epidemiology
Vietnam / epidemiology