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

Area of Science:

• Infectious Diseases
• Public Health
• Epidemiology

Background:

• Existing mortality and recurrence rates for rifampicin- or multidrug-resistant tuberculosis (RR/MDR-TB) are likely underestimated.
• Long-term disease outcomes for RR/MDR-TB patients require thorough investigation.

Purpose of the Study:

• To determine the long-term mortality and TB re-occurrence rates among individuals treated for RR/MDR-TB.
• To assess the accuracy of programmatic reporting of RR/MDR-TB outcomes.

Main Methods:

• A prospective cohort study was conducted in Vietnam with patients initiating WHO-recommended RR/MDR-TB regimens.
• Follow-up extended for ≥32 months, with vital status and subsequent TB episodes surveyed.
• Standardized mortality ratios (SMR) were calculated using household contacts as a reference population.

Main Results:

• 1755 patients were enrolled; 1364 were assessed at final follow-up (median 4.3 years).
• Overall mortality rate was 42.6/1000 person-years, with an overall SMR of 5.6.
• Tuberculosis (TB) was the cause of death in 96 participants; 43% of on-treatment deaths were unreported to the National TB Program (NTP).
• The rate of subsequent TB episodes was 10.3/1000 person-years.

Conclusions:

• RR/MDR-TB survivors face significant risks of mortality and TB recurrence.
• Programmatic reports underestimate true mortality rates during and after treatment.
• Strengthened programmatic follow-up and monitoring for TB recurrence are urgently needed.