Long-term Outcomes Among People With Multidrug-Resistant Tuberculosis in Vietnam: A Prospective Cohort Study

BACKGROUND: Existing rates of death and recurrent tuberculosis (TB) among people treated for rifampicin- or multidrug-resistant tuberculosis (RR/MDR-TB) are likely underestimates. We determined long-term disease outcomes among a cohort of people treated for RR/MDR-TB. METHODS: We conducted a prospective cohort study among patients treated by the National TB Program (NTP) in 10 provinces of Vietnam. Individuals with confirmed RR/MDR-TB starting World Health Organization-recommended regimens were followed up for ≥32 months. After this period, we surveyed the cohort to measure vital status and subsequent TB episodes. Family members completed verbal autopsies for deceased participants. We calculated rates of mortality and TB re-occurrence, and standardized mortality ratio (SMR) using participants' household contacts as a reference population. RESULTS: Between March 2016 and July 2020, 1755 patients were enrolled, of whom we assessed 1364 (77.7%) at final follow-up. Median follow-up time was 4.3 years. Successful treatment outcomes were reported for 1357/1755 (77.3%) individuals. From enrollment until end of follow-up, 289 participants died (16.5%; mortality rate, 42.6/1000 person-years); overall SMR was 5.6 and post-treatment SMR was 3.0. Tuberculosis was the probable or confirmed cause of death in 96 deceased participants. Many (71/165; 43.0%) deaths occurring on-treatment were not reported to the NTP. The rate of subsequent TB episodes among all participants, regardless of treatment outcome, was 10.3/1000 person-years. CONCLUSIONS: RR/MDR-TB survivors have high risks of mortality and re-occurring TB. Programmatic reports underestimate the true mortality rate both during and after treatment. Interventions are urgently needed to strengthen programmatic follow-up, improve treatment outcomes, and monitor for TB recurrence.