The burden of tuberculosis in Ho Chi Minh City, Vietnam: a spatial analysis of drug-susceptible and multi-drug resistant cases between 2020 and 2023

We characterised the spatial distribution of drug-susceptible (DS) and multi-drug resistant (MDR) tuberculosis (TB) cases in Ho Chi Minh City (HCMC), a major South-East Asian metropolis, and explored demographic and socioeconomic factors associated with local TB burden. Hot spots of DS- and MDR-TB incidence were observed in the central parts of HCMC, with substantial heterogeneity observed across wards. Positive spatial autocorrelation was observed for both DS- and MDR-TB. Ward-level TB incidence was associated with HIV prevalence (incidence rate ratio [IRR] 1.77, 95% CI 1.54-2.03) and the male proportion of the population (IRR 1.05, 95% CI 1.02-1.08). No ward-level demographic and socioeconomic indicators were associated with MDR-TB case count relative to total TB case count. Our findings may inform spatially-targeted TB control strategies and provide insights for generating hypotheses about the nature of the relationship between DS- and MDR-TB in HCMC, Vietnam and the wider South-East Asia region

Rifampicin resistant 'Mycobacterium tuberculosis' in Vietnam, 2020–2022

Objective: We conducted a descriptive analysis of multi-drug resistant tuberculosis (MDR-TB) in Vietnam’s two largest cities, Hanoi and Ho Chi Minh city. Methods: All patients with rifampicin resistant tuberculosis were recruited from Hanoi and surrounding provinces between 2020 and 2022. Additional patients were recruited from Ho Chi Minh city over the same time period. Demographic data were recorded from all patients, and samples collected, cultured, whole genome sequenced and analysed for drug resistance mutations. Genomic susceptibility predictions were made on the basis of the World Health Organization’s catalogue of mutations in Mycobacterium tuberculosis associated with drug resistance, version 2. Comparisons were made against phenotypic drug susceptibility test results where these were available. Multivariable logistic regression was used to assess risk factors for previous episodes of tuberculosis. Results: 233/265 sequenced isolates were of sufficient quality for analysis, 146 (63 %) from Ho Chi Minh City and 87 (37 %) from Hanoi. 198 (85 %) were lineage 2, 20 (9 %) were lineage 4, and 15 (6 %) were lineage 1. 17/211 (8 %) for whom HIV status was known were infected, and 109/214 (51 %) patients had had a previous episode of tuberculosis. The main risk factor for a previous episode was HIV infection (odds ratio 5.1 (95 % confidence interval 1.3–20.0); p = 0.021). Sensitivity for predicting first-line drug resistance from whole genome sequencing data was over 90 %, with the exception of pyrazinamide (85 %). For moxifloxacin and amikacin it was 50 % or less. Among rifampicin-resistant isolates, prevalence of resistance to each non-first-line drug was < 20 %. Conclusions: Drug resistance among most MDR-TB strains in Vietnam’s two largest cities is confined largely to first-line drugs. Living with HIV is the main risk factor among patients with MDR-TB for having had a previous episode of tuberculosis

A randomised controlled trial of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDITOF-MS) versus conventional microbiological methods for identifying pathogens: Impact on optimal antimicrobial therapy of invasive bacterial and fungal infections in Vietnam.

OBJECTIVES: We assessed the impact of MALDITOF-MS on the timeliness of optimal antimicrobial therapy through a parallel-arm randomised controlled trial in two hospitals in Vietnam. METHODS: We recruited patients with a pathogen (bacterial or fungal) cultured from a normally sterile sample. Samples were randomly assigned (1:1) to identification by MALDITOF-MS or conventional diagnostics. The primary outcome was the proportion on optimal antimicrobial therapy within 24 h of positive culture, determined by a blinded independent review committee. Trial registered at ClinicalTrials.gov (NCT02306330). RESULTS: Among 1005 randomised patients, pathogens were isolated from 628 (326 intervention, 302 control), with 377 excluded as likely contaminants or discharged/died before positive culture. Most isolates were cultured from blood (421/628, 67.0%). The proportion receiving optimal antimicrobial therapy within 24 h (the primary outcome) or 48 h of growth was not significantly different between MALDITOF-MS and control arms (135/326, 41.4% vs 120/302, 39.7%; Adjusted Odds ration (AOR) 1.17, p = 0.40 and 151/326, 46.3% vs 141/302, 46.7%; AOR 1.05 p = 0.79, respectively). CONCLUSIONS: MALDITOF-MS, in the absence of an antimicrobial stewardship programme, did not improve the proportion on optimal antimicrobial therapy at 24 or 48 h after first growth in a lower-middle income setting with high rates of antibiotic resistance

Is digital transformation a barrier to export reduction during COVID-19? The case of a developing country

AbstractThis paper investigates the impact of digital transformation on export reduction during COVID-19 by using unique data from Vietnamese manufacturing firms. Digital transformation reflects whether firms had already introduced digital technology before the COVID-19 outbreak or started using digital technology during the COVID-19 outbreak. Meanwhile, an export reduction is a partial de-internationalization in which firms decrease overseas sales. Estimation results from the instrumental variable probit method show that digital transformation has a negative effect on the probability of export reduction. This effect becomes particularly strong for micro, small and medium enterprises. Our findings have managerial implications for firm managers