TUBERCULOSIS | 2009
An ACT that influenced global guidance on tackling tuberculosis
How a study in Vietnam saved lives and scaled to help whole communities across the world
Thirty countries are listed by the World Health Organisation (WHO) as high burden for Tuberculosis (TB) – comprising almost 90% of new TB cases. Two in three cases of TB worldwide occur in the Asia-Pacific region.
In 2009, Professor Greg Fox set out to investigate better ways of controlling the spread of the disease in Vietnam, a nation which ranks 12th of the 30 high-burden countries and 10th for drug-resistant TB cases.
Armed with ambition and a lot of tenacity, Greg, under the mentorship of Professor Warwick Britton of the Centenary Institute, and Professor Guy Marks of the Woolcock Institute, set about building relationships and establishing a clinical trial to evaluate the effect of Active Case Finding. Called the ACT 2 study, this project was conducted in 70 hospitals around the country.
“In the beginning, it was just me in Vietnam, representing Centenary and the Woolcock Institutes. We established local licenses to conduct this research, and travelled across the country, collaborating with doctors and nurses in TB hospitals across eight provinces,” recalls Greg.
Collaborations and scaling up
Working closely with the Vietnam National Tuberculosis Program (NTP) and the National Lung Hospital in Hanoi, which would go on to be a long-term collaborator, the trial was supported by over 200 members of the NTP network.
“What started with a pilot in four hospitals in Hanoi, grew to a research team that was able to implement the project at scale. The project was funded by a grant from Australia’s National Health and Medical Research Council (NHMRC).”
Greg remembers it as a steep learning curve, but one that was worth it.
“Following the pilot study, we undertook the large cluster-randomised controlled trial, specifically looking at systematic screening of households four times over two years. We recruited over 25,000 people at risk of TB, as well as 10,000 people affected by TB.”
It was work that paid off. The findings of the ACT 2 trial were published in the New England Journal of Medicine. Together, Greg and collaborators Professor Warwick Britton of the Centenary Institute and Professor Guy Marks of the Woolcock Institute of Medical Research, demonstrated that household-contact investigation combined with standard passive case finding increased, early detection of TB cases, compared to passive case finding alone.
This resulted in a series of studies that evaluated other aspects of TB case detection and research is ongoing.
Real-world results
“As we widened out the programs beyond households and into the general community, we were able to see the real-world impact even more clearly. The ACT 3 trial found that community-wide screening almost halved the prevalence of TB and reduced transmission of the bacteria that cause TB to children,” says Greg.
Research and action in high burden TB countries such as Vietnam have the greatest potential to curb the global TB epidemic.
Greg’s research set the foundations for ongoing investigations, together with his partners in Vietnam. These studies provided the evidence needed to change global guidance for TB screening. In 2020, following the study findings being presented to the WHO, the organisation recommended that contact tracing be adopted around the world.
This program of research aims to reduce the spread of TB, save lives, and bring the world closer to the goal of ending TB as a public health threat. The impact of this research is already being felt across the globe.