In the second half of 2012 and in the first half of 2013 Luan moved to Vietnam to implement the expansion of Operation ASHA. However, Operation ASHA management decided to forego the expansion for various reasons. Since Luan had already sensitized the various stakeholders in the local public health system and development field for a potential project in TB control, the society attempted to find a new partner to carry out the implementation.
This partner was found in the form of the Public Health Association HCMC. After we finalized our partnership agreement with the Public Health Association HCMC towards the end of 2013, we had to submit an application with the municipal leadership for approval of our project. As expected, through the close relationship of our partner with the local authorities, we received approval within a month of submission, when the same application would typically require a processing time of around 3-6 under normal circumstances. Subsequently, following a few initial obstacles we were able to transfer the first tranche of funding for the launch of the project in February.
In light of the World TB Day, the project held a large scale project kick-off meeting for the district’s municipal leaders and representatives of the public healthcare system in which the project will be implemented as well as a dozen private providers. The presentation intended to introduce the project to the attendees as well as obtain their feedback and concerns. In the end, the 3-hour long meeting was highly successful and many of the attendees committed to support the project within their areas of responsibility.
Project PROPER CARE
Our project PROPER CARE, which stands for PPM-driven Reinforcement Of Patient Enrollment and Retrieval, Community Advocacy, Reach and Engagement, has been operating since April 2014. The core goals of the project are to increase new case detections and minimize losses to follow-up. The project’s activities are based on three main strategies of active advocacy and case finding, holistic engagement of public and private TB care stakeholders and comprehensive care for patients and their families. The project covers the entire Go Vap district, which houses about 650,000 people according to the local health department (as of January 2016) and of whom almost half are internal migrants. The project currently has 12 employees including 11 counselors and 1 team manager. Furthermore, we have built a network of approximately 50 private clinics and 200 pharmacies that support our advocacy work.
Overall in 2015, we have reached out to 61,501 households with 269,244 people to ask about TB symptoms. Our counselors managed to convince 1,480 suspects showing TB-related symptoms to get tested free of charge. In doing so, we significantly raised the monthly average of people tested by the District TB Unit from approximately 130 people per month to about 200 people per month. The number of patients managed has risen from 157 at the start of our operations to 452 at the end of the year.
Most importantly for our project, however, are the new detections that we find in the community from our active outreach work as well as following up with cases to prevent losses to follow-up. By the end of 2015 we were able to increase enrollment by 2.9% compared to the prior year and 13.4% compared to the baseline prior to our intervention. Our results in terms of default rate were even better still. We were able to vastly surpass our target of 4% with a final loss to follow-up rate of 0.7%, which contributed significantly to the prevention of drug resistance.
The value perception for our project is likely best expressed through a quote from one of our sponsors as Peter Kanabus, head of the charity Global Health & Education (GHE), stated in the following comment: “I believe the project has achieved all of what we expected, and overcome additional problems which were not expected. I think that you can be proud of what you have achieved. The number of patients helped is very impressive and the cost makes it even more so. Thank you for the effort that you have put in.“
Past and current sponsors of the project include GHE, Otsuka, Janssen (pharmaceutical company of Johnson & Johnson), Licata Catering, Emcosys GmbH, Restaurant Quan Van, the many friends of FIT and its members.