An Effective Health System Approach to End TB: Implementing the Double X Strategy in Vietnam

This study aimed to evaluate Vietnam’s Double X (2X) strategy, which integrates chest radiography (CXR) and GeneXpert (Xpert) rapid diagnostic testing to improve early tuberculosis (TB) detection, particularly among vulnerable populations and household contacts. The study analyzed data from March 2020 to December 2022 across nine provinces in Vietnam, screening 100,580 individuals through active case-finding (ACF) and 573,944 individuals through intensified case-finding (ICF) in health facilities. The number needed to screen (NNS) with CXR to diagnose one TB case was 11 for self-screeners, 60 for community vulnerable populations, 19 in facilities, and 154 for household contacts. The use of computer-aided diagnosis (CAD) for CXR improved physicians’ interpretations and Xpert referral decisions. The study found that the 2X strategy improved access to TB services, decentralized screening to lower healthcare levels, and contributed to post-COVID-19 TB recovery. The findings suggest that integrating CAD with CXR screening can optimize TB detection and enhance healthcare system efficiency in high-burden settings.