Evaluating treatment outcomes for patients with multidrug-resistant tuberculosis in Vietnam

Tuberculosis (TB) is the ninth leading cause of death worldwide, with an estimated 1.7 billion people currently affected by the disease. Multidrug resistant tuberculosis (MDR-TB) is not responsive to the most effective first-line drug treatments, and is a significant public health issue facing many nations including Vietnam. New drug regimens that improve treatment outcomes and reduce toxicity are urgently needed. However, the specific factors associated with poor treatment outcomes in Vietnam have not been well characterised. This thesis explores major obstacles to successful outcomes for patients with drug-resistant TB in Vietnam. Firstly, patient-related factors associated with poor outcomes were explored in a retrospective cohort study among patients treated for MDR-TB in two provinces. Second, treatment-related factors were evaluated through a systematic review and meta-analysis. This explored the incidence of ototoxicity due to injectable antibiotics, which can contribute to long-term morbidity even after treatment has been ‘successful’. Together, these studies highlight major challenges in the programmatic management of MDR-TB and highlight the urgent need for new approaches to control drug-resistant TB in resource-limited settings.