Hai Duong effectively applies molecular biology testing techniques in diagnosing tuberculosis

Sensitive and specific

Along with the whole country, Hai Duong is implementing the "2X" strategy (chest X-ray and GeneXpert test) in diagnosing tuberculosis. In the above strategy, GeneXpert is a breakthrough molecular biology technique that allows the identification of tuberculosis bacteria at low levels with high sensitivity and specificity.

Master, specialist doctor II Phan Thi Hoai Thu, Deputy Director of Hai Duong Lung Hospital, said that previously, tuberculosis diagnosis was mainly based on the method of culturing and examining fresh sputum. This method requires about 5,000-10,000 bacteria in a microscopic field and takes a long time to "examine" the results. However, the specificity of the fresh sputum examination method is not high, making it difficult to distinguish between human tuberculosis, bovine tuberculosis, and bird tuberculosis.

With GeneXpert, the sensitivity and specificity in diagnosing tuberculosis are many times more effective. "As long as the sample has 150 bacteria or more, this test method can accurately determine the result, what type of tuberculosis it is and whether it is drug-resistant tuberculosis or not. After 2 hours from running the sample, GeneXpert gives the result, while with the conventional method it takes several days," Dr. Thu informed.

On March 18, patient NTM (20 years old, from Kim Thanh) came to Hai Duong Lung Hospital for examination in a state of fatigue, intermittent fever, dry, prolonged cough, sweating... Ms. M. had a sputum sample taken for testing using the GeneXpert method. In just the morning, the doctor determined that she had tuberculosis but the concentration of bacteria was still low, not drug-resistant tuberculosis, and provided a targeted, effective treatment method.

Hai Duong Lung Hospital currently has 4 GeneXpert machines, supported by the National Tuberculosis Control Program through international organizations. Head of the Microbiology Department Nguyen Thi Thanh said that GeneXpert is an integrated technique of 3 technologies: gene separation, gene cloning and gene recognition, but the operating process is very simple.

After the sample is processed into a suspension, it will be put into the automatic machine. After this process, information about the sample such as positive or negative, low or high level of tuberculosis bacteria, drug-resistant or non-resistant tuberculosis... will be displayed immediately on the computer screen connected to the GeneXpert machine. "Just by looking at this, doctors can easily come up with effective treatment methods for each patient," said Ms. Thanh.

Resources needed for scaling

Dr. Thu said that the application of GeneXpert technology has been and is being effectively applied in diagnosing tuberculosis patients in hospitals. Every year, this technique is also applied in tuberculosis screening in the community, but the scope is not wide and is mainly given priority to people with weakened immune systems, HIV or chronic diseases related to the kidneys, liver, alcoholism...

Since receiving support from the National Tuberculosis Control Program, Hai Duong has only been able to deploy this technique in two district-level localities each year. Some health managers said that in order to properly assess the situation and effectively implement the tuberculosis control strategy, GeneXpert technique needs to be deployed in at least six localities each year.

According to the reporter's research, it is possible that from 2025, funding sources to support GeneXpert technology in Vietnam will be reduced or no longer exist. Meanwhile, Hai Duong is one of the 20 provinces and cities with the highest tuberculosis prevalence rate in the country. To ensure the annual tuberculosis prevention plan and goals, in addition to maintaining traditional methods such as chest X-ray and fresh examination, it is necessary to continue to maintain GeneXpert technology.

The biggest difficulty at present is that Vietnam has not been able to produce biological products to serve the GeneXpert testing technique, and buying them from abroad requires a large amount of funding.

In early February this year, the Central Lung Hospital announced that the National Tuberculosis Control Program no longer had funds to purchase chemicals and supplies for sputum testing directly for the Tuberculosis Control Programs of provinces and cities nationwide. Therefore, provinces and cities, including Hai Duong, need to proactively allocate local budgets to purchase chemicals and supplies for tuberculosis diagnostic testing.

Over the years, Hai Duong has always paid attention to tuberculosis prevention. However, frankly admitting that the resources for this activity are still modest. To achieve the strategic goal of ending tuberculosis with the whole country by 2035, Hai Duong needs to continue to pay attention and synchronously deploy solutions, especially investing enough resources to deploy advanced and modern techniques, including GeneXpert.