Adverse events in the treatment of MDR-TB patients within and outside the NTP in Pham Ngoc Thach hospital, Ho Chi Minh City, Vietnam

Abstract

Background: Treatment outcomes of a high proportion of inpatients with multi-drug resistant tuberculosis (MDR-TB) were not reported to the Vietnamese National Tuberculosis Program because they received treatment outside of the green light committee (GLC) program. The study aimed (1) to describe the strengths and weaknesses of treatment of GLC and non-GLC MDR-TB patients as well as the factors influencing treatment completion and (2) to determine the incidence of adverse drug reactions.

Results: This cross-sectional study comprised two elements: (1) in-depth interviews with clinical doctors, hospital pharmacists; and focus group discussions with MDR-TB patients; and (2) a review of the charts of all GLC and non-GLC MDR-TB patients in 2010. A total of 282 MDR-TB patients were recruited, including 79(28%) MDR-TB patients treated through the GLC program and 203(72%) MDR-TB patients treated outside of the GLC program. The main strengths of GLC treatment were the supply of quality assured second line TB drugs, routine monitoring and clinical evaluation, free diagnostic tests and close clinical monitoring. The greatest barriers to patients treated outside of the GLC program was difficulty paying for second line TB drugs and other treatment costs. There was no significant difference between the incidence of adverse events among GLC (46.8%) and non-GLC treated patients (52.2%; p = 0.417). Among 143 patients who reported 226 adverse reaction events, arthralgia/joint pain (35.8%), gastrointestinal (14.2%), ototoxicity (8.4%), cutaneous (6.6%), and giddiness (5.8%) were the most common.

Conclusions: The non-GLC MDR-TB patients face substantial barriers to treatment, and require greater support if they are to complete treatment and improve disease outcomes. Staff training about the management of adverse drug reactions is needed.