Management and treatment outcomes of patients enrolled in MDR-TB treatment in Viet Nam

Phương, Nguyễn Thu; Nhung, Nguyen Viet; Hoa, Nguyen Binh; Thủy, Hoàng Thị Thanh; Takarinda, K. C.; Tayler-Smith, K.; Harries, A. D.

doi:10.5588/pha.15.0068

Cited by 20 publications

(29 citation statements)

References 15 publications

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“…Patients were hospitalized in PNTH for 7 to 14 days to initiate treatment, and then referred to DTUs for outpatient follow-up. Treatment modalities did not change during the study time, with the standardized combination of 6 drugs for a total of 18 to 24 months of treatment (2).…”

Section: Study Setting and Populationmentioning

confidence: 99%

“…Ho Chi Minh City (HCMC) is the most populous city in Vietnam (around 8 million people) and also the center for TB and drug-resistant TB management in Southern Vietnam. In 2009, the Vietnam National TB Programme initiated the Programmatic Management of Drug-resistant TB (PMDT) under the support of Global Fund (Switzerland) to provide free treatment and support for MDR-TB patients (2). Pham Ngoc Thach hospital (PNTH) is a tertiary referral center for TB and lung diseases in Southern Vietnam, which provided treatment for 81% of registered MDR-TB patients in Vietnam in 2010 (8).…”

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confidence: 99%

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Risk factors for poor treatment outcomes of 2,266 multidrug-resistant tuberculosis cases in Ho Chi Minh City: a retrospective study

Van

Phu

Vinh

et al. 2019

Preprint

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Background: Multidrug resistant tuberculosis (MDR-TB) remains a serious public health problem with poor treatment outcomes. Predictors of poor outcomes vary in different regions. Vietnam is among the top 30 high burden of MDR-TB countries. We describe demographic characteristics and identify risk factors for poor outcome among patients with MDR-TB in Ho Chi Minh City (HCMC), the most populous city in Vietnam. Methods: This retrospective study included 2,266 patients who initiated MDR-TB treatment between 2011-2015 in HCMC. Treatment outcomes were available for 2,240 patients. Data was collected from standardized paper-based treatment cards and electronic records. A Kruskal Wallis test was used to assess changes in median age and body mass index (BMI) over time, and a Wilcoxon test was used to compare the median BMI of patients with and without diabetes mellitus. Chi squared test was used to compare categorical variables. Multivariate logistic regression with multiple imputation for missing data was used to identify risk factors for poor outcomes. Statistical analysis was performed using R program. Results: Among 2,266 eligible cases, 60.2% had failed on a category I or II treatment regimen, 57.7% were underweight, 30.2% had diabetes mellitus and 9.6% were HIV positive. The notification rate increased 24.7% from 2011-2015. The treatment success rate was 73.3%. Risk factors for poor treatment outcome included HIV co-infection (adjusted odds ratio (aOR): 2.94), advanced age (aOR: 1.45 for every increase of 5 years for patients 60 years or older), having history of MDR-TB treatment (aOR: 5.53), sputum smear grade scanty or 1+ (aOR: 1.47), smear grade 2+ or 3+ (aOR: 2.06), low BMI (aOR: 0.83 for every increase of 1kg/m2 of BMI for patients with BMI<21). Conclusion: The number of patients diagnosed with MDR-TB in HCMC increased by almost a quarter between 2011-2015. Patients with HIV, high smear grade, malnutrition or a history of previous MDR-TB treatment are at greatest risk of poor treatment outcome.

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Section: Study Setting and Populationmentioning

confidence: 99%

mentioning

confidence: 99%

Risk factors for poor treatment outcomes of 2,266 multidrug-resistant tuberculosis cases in Ho Chi Minh City: a retrospective study

Van

Phu

Vinh

et al. 2019

Preprint

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“…By 2012, computers had become widespread at district health centers, and in 2016, the Government of Vietnam set the goal that 99% of health facilities would have broadband internet access by 2020 [1,5]. A number of eHealth projects have been implemented in Vietnam, often through donor financing, to support patient management and case reporting, with varying degrees of success [6,7,8].…”

Section: Introductionmentioning

confidence: 99%

Open-source LIMS in Vietnam: The path toward sustainability and host country ownership

Landgraf¹,

Kakkar

Meigs

et al. 2016

International Journal of Medical Informatics

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“…In Sub-Saharan Africa, a resource limited setting, the true burden of drug resistant TB is unknown as most countries have not conducted drug resistant surveys (DRSs). To make matters worse, treatment of patients with DR-TB is either inadequate or lacking (2,13). This precedent has resulted into DR-TB patients diagnosed being put on treatment waiting lists as affected countries try to establish or scale up PMDT treatment programs.…”

Section: Introductionmentioning

confidence: 99%

Addressing the drug resistant tuberculosis challenge through implementing a mixed model of care in Uganda, 2012- 2017

Kasozi

Kirirabwa

Kimuli

et al. 2019

Preprint

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Background Worldwide, Drug resistant Tuberculosis (DR-TB) remains a big problem; the diagnostic capacity has superseded the DR-TB clinical management capacity thereby causing ethical challenges. In Sub-Saharan Africa, treatment is either inadequate or lacking and some diagnosed patients are on treatment waiting lists. In Uganda, various health system challenges impeded scale up of DR-TB care in 2012; only three treatment initiation facilities existed, with only 41 of the estimated 1010 cases enrolled on treatment yet 300 were on the waiting list and there was no DR-TB treatment scale up plan. To scale up care, National TB/Leprosy Program (NTLP) with partners rolled out a DR-TB mixed model of care. In this paper, we share achievements and outcomes resulting from the implementation of this mixed Model of DR-TB care. Methods Routine NTLP DR-TB program data from 2013 to 2017 cohorts was collected from all the 15 DR-TB treatment initiation sites and analyzed using STATA version 14.2. We presented outcomes as the number of patient backlog cleared, DR-TB initiation sites, cumulative patients enrolled, percentage of co-infected patients on co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART) as well as the six, twelve interim and 24 months treatment outcomes as per the Uganda NTLP 2016 Programmatic Management of drug Resistant Tuberculosis (PMDT) guidelines. Results Over the period 2013-2017, DR-TB treatment initiation sites increased from three to 15, cumulative patient enrollment rose from 41 to 1,311 and the 300-patient backlog was cleared. Treatment success rate (TSR) of 73% was achieved above the global TSR average rate of 50%. Conclusions The Uganda DR-TB mixed model of care coupled with early application of continuous improvement approaches, enhanced cohort reviews and use of multi-disciplinary teams allowed for rapid DR-TB program expansion, rapid clearance of patient backlog, attainment of high cumulative enrollment and high treatment success rates. Sustainability of these achievements is needed to further reduce the DR-TB burden in the country. We highly recommend this mixed model of care in settings with similar challenges.

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Management and treatment outcomes of patients enrolled in MDR-TB treatment in Viet Nam

Cited by 20 publications

References 15 publications

Risk factors for poor treatment outcomes of 2,266 multidrug-resistant tuberculosis cases in Ho Chi Minh City: a retrospective study

Risk factors for poor treatment outcomes of 2,266 multidrug-resistant tuberculosis cases in Ho Chi Minh City: a retrospective study

Open-source LIMS in Vietnam: The path toward sustainability and host country ownership

Addressing the drug resistant tuberculosis challenge through implementing a mixed model of care in Uganda, 2012- 2017

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