A qualitative assessment on the acceptability of providing cash transfers and social health insurance for tuberculosis-affected families in Ho Chi Minh City, Vietnam

To achieve the Sustainable Development Goal’s targets of universal health coverage (UHC) and poverty reduction, interventions are required that strengthen and harmonize both UHC and social protection. Vietnam is committed to achieving financial protection and over 90% of the general…Read More »

Prevent TB to end TB

Tuberculosis (TB) is the leading cause of infectious disease deaths globally, killing three people every minute.1 The World Health Organization (WHO) published its End TB Strategy1 2 in 2015, which set ambitious and laudable targets to reduce global incidence by…Read More »

Optimising diagnosis and treatment of tuberculosis infection in community and primary care settings in two urban provinces of Vietnam: a cohort study

This cohort study was implemented in two provinces of Vietnam from May 2019 to September 2020. Participants included household contacts (HHCs), vulnerable community members and healthcare workers (HCWs) recruited at community-based TB screening events or HHC investigations at primary care…Read More »

Development of treatment-decision algorithms for children evaluated for pulmonary tuberculosis: an individual participant data meta-analysis

For this meta-analysis, we identified individual participant data from a WHO public call for data on the management of tuberculosis in children and adolescents and referral from childhood tuberculosis experts. We included studies that prospectively recruited consecutive participants younger than…Read More »

High-throughput phenogenotyping of Mycobacteria tuberculosis clinical strains reveals bacterial determinants of treatment outcomes

We developed a high-throughput functional genomics platform for defining genotype-phenotype relationships across a panel of Mtb clinical isolates. These phenotypic fitness profiles function as intermediate traits which can be linked to Mtb genetic variants and associated with clinical and epidemiological…Read More »

Comparing cross-sectional and longitudinal approaches to tuberculosis patient cost surveys using Nepalese data

The World Health Organization has supported the development of national tuberculosis (TB) patient cost surveys to quantify the socio-economic impact of TB in high-burden countries. However, methodological differences in the study design (e.g. cross-sectional vs longitudinal) can generate different estimates…Read More »

Quantifying the potential epidemiological impact of a 2-year active case finding for tuberculosis in rural Nepal: a model-based analysis

Using village development committee (VDC)-level data on TB notification and demography between 2016 and 2017 in four southern districts of Nepal, where ACF activities were implemented as a part of the IMPACT-TB study between 2017 and 2019, we developed VDC-level…Read More »

Evolution and transmission of antibiotic resistance is driven by Beijing lineage Mycobacterium tuberculosis in Vietnam

A previous investigation has elucidated the landscape of Mtb genomic diversity and transmission dynamics in Ho Chi Minh City, Vietnam. Here, we expand the scope of this survey by adding a substantial number of additional genomes (total sample size: 2,542)…Read More »

Comparing Additionality of Tuberculosis Cases Using GeneXpert or Smear-Based Active TB Case-Finding Strategies among Social Contacts of Index Cases in Nepal

This study compares the yield and additionality of community-based active tuberculosis (TB) active case-finding strategies using either smear microscopy or GeneXpert as the TB diagnostic test. Active case-finding strategies screened social contacts of index cases and high-risk groups in four…Read More »

Use of big data on the social determinants of TB to find the “missing millions”

The WHO and the United Nations Sustainable Development Goals (SDGs) aim to end TB disease by 2030, highlighting the need for active case-finding as part of an integrated approach to finding the ‘missing millions’. The data sources that are typically…Read More »

Feasibility of HPV self-sampling pathway in Kathmandu Valley, Nepal using a human-centred design approach

Cervical cancer is preventable and curable yet causes almost 2000 deaths in Nepali women each year. The present study aims to explore the feasibility and acceptability of a self-sampling-based approach for cervical cancer screening in urban and peri-urban Nepal and…Read More »

Independent evaluation of 12 AI solutions for the detection of TB

There have been few independent evaluations of computer-aided detection (CAD) software for tuberculosis (TB) screening, despite the rapidly expanding array of available CAD solutions. We developed a test library of chest X-ray (CXR) images which was blindly re-read by two…Read More »

Socio-protective effects of ACF on catastrophic costs from TB in Vietnam

Many TB patients incur catastrophic costs. Active case finding (ACF) may have socio-protective properties that could contribute to the WHO End TB Strategy target of zero TB-affected families suffering catastrophic costs, but available evidence remains limited. This study measured catastrophic…Read More »

Barriers and facilitators to accessing tuberculosis care in Nepal

Psychosocial and economic (socioeconomic) barriers, including poverty, stigma and catastrophic costs, impede access to tuberculosis (TB) services in low-income countries. We aimed to characterise the socioeconomic barriers and facilitators of accessing TB services in Nepal to inform the design of…Read More »

The impact of ACF on transmission dynamics of TB: A modelling study

We adopted a dynamic transmission model that incorporates heterogeneity in risk to TB to assess the impact of an ACF programme (IMPACT TB) on reducing TB incidence in Vietnam and Nepal. We fitted the models to country-level incidence data using…Read More »

Capitalizing on facilitators and addressing barriers when implementing active tuberculosis case-finding in six districts of Ho Chi Minh City

In this publication, we provide insights into facilitators, barriers and “how-to” strategies for active case-finding (ACF) implementation in Vietnam, applying an implementation science framework. We captured perceptions from key stakeholders involved in ACF implementation, including patients, employees, volunteers and leaders.…Read More »

Comparative Yield of Tuberculosis during Active Case Finding Using GeneXpert or Smear Microscopy for Diagnostic Testing in Nepal

This study compared the yield of tuberculosis (TB) active case finding (ACF) interventions applied under TB REACH funding. Between June 2017 to November 2018, Birat Nepal Medical Trust identified presumptive cases using simple verbal screening from three interventions: door-to-door screening…Read More »

Building on facilitators and overcoming barriers to implement active tuberculosis case-finding in Nepal

Based on interviews with community health workers and people with TB, we described the facilitators and barriers linked to the implementation of active case-finding within the IMPACT TB project (, and also described how those facilitators and barriers have been…Read More »

‘A double-edged sword’: Perceived benefits and harms of active case finding for people with presumptive tuberculosis and communities-A qualitative study based on expert interviews

The study showed the importance of considering the benefits and harms of ACF throughout the screening pathway, not just in the planning phase. On the one hand, the perceived benefits of ACF included reaching vulnerable populations, reducing patient costs, helping…Read More »

Developing Feasible, Locally Appropriate Socioeconomic Support for TB-Affected Households in Nepal

Tuberculosis (TB), the leading single infectious diseases killer globally, is driven by poverty. Conversely, having TB worsens impoverishment. During TB illness, lost income and out-of-pocket costs can become “catastrophic”, leading patients to abandon treatment, develop drug-resistance, and die. WHO’s 2015…Read More »

Sources of Multidrug Resistance in Patients With Previous Isoniazid-Resistant Tuberculosis Identified Using Whole Genome Sequencing: A Longitudinal Cohort Study

Meta-analysis of patients with isoniazid-resistant tuberculosis (TB) given standard first-line anti-TB treatment indicated an increased risk of multidrug-resistant TB (MDR-TB) emerging (8%), compared to drug-sensitive TB (0.3%). Here we use whole genome sequencing (WGS) to investigate whether treatment of patients with pre-existing…Read More »

A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City

We conducted a two-year, controlled intervention study in 12 districts of Ho Chi Minh City, Viet Nam. We engaged CHWs as salaried employees (3 districts) or incentivized volunteers (3 districts) to conduct ACF among contacts of people with TB and urban priority…Read More »

Characterization of DNA methylation in Malawian Mycobacterium tuberculosis clinical isolates

Although Mycobacterium tuberculosis (Mtb) strains exhibit genomic homology of >99%, there is considerable variation in the phenotype. The underlying mechanisms of phenotypic heterogeneity in Mtb are not well understood but epigenetic variation is thought to contribute. At present the methylome of Mtb has…Read More »

Research protocol for a mixed-methods study to characterise and address the socioeconomic impact of accessing TB diagnosis and care in Nepal

This mixed-methods study in Nepal will: evaluate the socioeconomic impact of accessing TB diagnosis and care (Project 1); and create a shortlist of feasible, locally-appropriate interventions to mitigate this impact (Project 2). The study will be conducted in the Chitwan, Mahottari, Makawanpur, and Dhanusha…Read More »

How to reduce household costs for people with tuberculosis: a longitudinal costing survey in Nepal

The aim of this study was to compare costs and socio-economic impact of tuberculosis (TB) for patients diagnosed through active (ACF) and passive case finding (PCF) in Nepal. A longitudinal costing survey was conducted in four districts of Nepal from…Read More »

Enhanced Private Sector Engagement for Tuberculosis Diagnosis and Reporting through an Intermediary Agency in Ho Chi Minh City

Under-detection and -reporting in the private sector constitute a major barrier in Viet Nam’s fight to end tuberculosis (TB). Effective private-sector engagement requires innovative approaches. We established an intermediary agency that incentivized private providers in two districts of Ho Chi…Read More »

Evaluating the yield of systematic screening for tuberculosis among three priority groups in Ho Chi Minh City, Viet Nam

In our two-year intervention study lasting from October 2017 to September 2019, CHWs in six districts of Ho Chi Minh City, Viet Nam verbally screened three urban priority groups: (1) household TB contacts; (2) close TB contacts; and (3) residents…Read More »

An Evaluation of Programmatic Community-Based Chest X-ray Screening for Tuberculosis in Ho Chi Minh City, Vietnam

In Vietnam, due to the cost of human resource capacity-building, laboratory and equipment infrastructure and molecular assay kits, the Ministry of Health requires further evidence on the marginal yield and associated costs to formalize the scale up and transition to…Read More »

Active case-finding policy development, implementation and scale-up in high-burden countries: A mixed-methods survey with National Tuberculosis Programme managers and document review

The results show that National TB Programme (NTP) managers agree on the need for active case-finding scale-up, which was also reflected in the national TB strategies that we reviewed, while not all strategies included explicit aims and targets related to…Read More »

‘Power plays plus push’: experts’ insights into the development and implementation of active tuberculosis case-finding policies globally, a qualitative study

This study highlighted the perceived need among experts for different types of evidence for ACF policy development and implementation, and for stakeholder engagement including researchers and policymakers to foster evidence use. Interviewees stressed the influence of government, donor and non-governmental…Read More »

Introducing Risk Inequality Metrics in Tuberculosis Policy Development

Global stakeholders including the World Health Organization rely on predictive models for developing strategies and setting targets for tuberculosis care and control programs. Failure to account for variation in individual risk leads to substantial biases that impair data interpretation and…Read More »

Tuberculosis Among Economic Migrants: A Cross-Sectional Study of the Risk of Poor Treatment Outcomes and Impact of a Treatment Adherence Intervention Among Temporary Residents in an Urban District in Ho Chi Minh City

This cross-sectional study evaluated WHO-defined TB treatment outcomes among economic migrants in an urban district of Ho Chi Minh City, Viet Nam. We measured the association of a patient's government-defined residency status with treatment success and loss to follow-up categories…Read More »

Factors Influencing Active Tuberculosis Case-Finding Policy Development and Implementation: A Scoping Review

Based on the studies included in the review, we know little about what impacts the development of policies for active case-finding, but we know a lot about what helps putting them into practice. Hopefully, this study can help explore active…Read More »

The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal.

The World Health Organization (WHO) End TB Strategy has established a milestone to reduce the number of tuberculosis (TB)- affected households facing catastrophic costs to zero by 2020. The role of active case finding (ACF) in reducing patient costs has…Read More »

Addressing social determinants to end tuberculosis

IMPACT TB's Tom Wingfield is the lead author of this article on TB and social determinants, published 24th March 2018 in The Lancet.Read More »

South Asia today: William Osler’s world with Antibiotics

Our IMPACT-TB co-investigator and leading Nepali ID researcher Professor Buddha Basnyat reminds us in a Lancet ID comment piece not to neglect the ancient wisdoms of infectious disease control in our quest for advanced solutions.Read More »

Tuberculosis in South Asia: a tide in the affairs of men

Professor Buddha Basnyat, Dr Maxine Caws and Dr Zarir Udwadia's article on Tuberculosis in South Asia, published 22nd March 2018.Read More »

Frequent transmission of the Mycobacterium tuberculosis Beijing lineage and positive selection for the EsxW Beijing variant in Vietnam

This study led by IMPACT TB PI Maxine Caws and Sarah Dunstan, looked at TB bacilli circulating in Ho Chi Minh City and identified hypervirulent strains with high transmisibility and broader host range. Published in Nature Genetics on 21st May…Read More »

Report on the Workshop for Sharing Experiences and Improving Management of TB Infection

IMPACT TB's Luan Vo, CEO and co-founder of Friends for International TB Relief, provides a report on the 'Workshop for Sharing Experiences and Improving Management of TB Infection' held 21-22 November 2017. Link to full pdf provided below.Read More »

Peer-reviewed article on the role and influence of good facilitation on the success of a policy dialogue

A facilitator “makes or breaks” a policy dialogue's success. In this qualitative study, published in the International Journal of Health Governance, Olivia Biermann and colleagues investigate the role and influence a facilitator has on the process and impact of a…Read More »

Op-ed piece on “Community-Based Tuberculosis Screening- a Double Edged Sword?

IMPACT TB’s PhD student Olivia Biermann from Karolinka Institutet describes the background behind her PhD project, and why it is a complex and challenging task to make and implement good active TB case finding policies… Read moreRead More »

Meeting report on IMPACT TB workshop Vietnam

IMPACT TB convened a workshop in partnership with the National Tuberculosis Programme of Vietnam and relevant stakeholders. The meeting was attended by representatives of the National TB Programme, World Health Organisation, TB Reach partnership (STOP TB), Clinton Health access Initiative…Read More »

Meeting report on IMPACT TB workshop Nepal

IMPACT TB convened a workshop in partnership with the National Tuberculosis Centre of Nepal and relevant stakeholders. The meeting was attended by representatives of the Ministry of Health, Department of Health Services, World Health Organisation and relevant governmental and non-governmental…Read More »