Viet Nam: optimism for multidrug-resistant TB patients

March 2013

Viet Nam has seen encouraging results in dealing with multidrug-resistant TB (MDR-TB) as this feature on one young woman from northern Viet Nam shows.

“The pain in my upper back came first, then it became hard to breathe and my chest hurt,” says Thanh, a 24-year-old wife and mother, as she describes her early symptoms of tuberculosis. She was diagnosed last year at the community health post near her farm in northern Viet Nam, and started taking medicines right away. But after eight months of taking anti-TB drugs, her health did not improve. The medicines were not working and she began to lose hope of being cured.

Then her doctor sent her to Hanoi Lung Hospital, 35km away, where a newly refurbished unit handles suspect cases of multidrug-resistant TB (MDR-TB). Two months later, Thanh is responding well to treatment and she is optimistic about returning home to finish the 18-24 month course of treatment with her husband as caregiver.

Thanh spends her days reading and resting in a patient bed during her hospital treatment stay.
WHO/E. Eraly

Resistance to anti-TB drugs

MDR-TB is a potentially deadly, hard-to-treat form of TB that is resistant to the most powerful TB drugs, isoniazid and rifampicin. Resistance to anti-TB drugs can occur when doctors do not prescribe appropriate treatment regimens or when patients misuse or mismanage anti-TB drugs, for example by not completing the full treatment. It can also occur if medicines are of poor quality.

Investing in health services to control MDR-TB

Viet Nam is one of 27 countries globally with a high burden of MDR-TB.

“Viet Nam is committed to fighting TB and its treatment success rate is consistently high – exceeding 90% for reported cases,” says Dr Takeshi Kasai, the WHO Representative in the country.

“But the continuing spread of MDR-TB could change all that. If we don’t invest in health services at every level to face the challenge of drug resistance, we will have a much bigger problem to cope with later,” he says.

“Previously there was no chance for these patients but now we see people get better. The results encourage us.”

Dr Le Minh Hoa, head of MDR-TB unit, Hanoi Lung Hospital

Step by step, Viet Nam is establishing gold-standard laboratory, clinical, drug procurement, planning and monitoring services to better assess and control MDR-TB.

“It has taken four years to get the technical capacity, facilities and funding in place to roll out services, and we are now seeing results in places such as the Hanoi Lung Hospital,” says Dr Cornelia Hennig, from WHO’s Stop TB Department in Hanoi.

Installation of a new diagnostic device that can test patients for TB and rifampicin resistance in just 100 minutes (known as Xpert MTB/RIF) is a “qualitative leap forward,” says Hennig.

Technical support from WHO and partners and funding from The Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States Agency for International Development have been critical to the progress.

MDR-TB treatment sites show encouraging results

So far, two patients have been cured at the hospital and 75 are enrolled.

The hospital is one of 10 treatment sites for MDR-TB across the country. Staff from the different hospitals regularly share lessons learned by videoconference to ensure the quality of patient management.

“The hardest part of my job is infection control, training staff and being sure that equipment is there to minimize risk,” says Dr Le Minh Hoa, head of the hospital’s MDR-TB unit. “The effort is high but so are the personal rewards,” she explains.

Microscopy to diagnose TB in the lab.
WHO/E. Eraly

“Previously there was no chance for these patients but now we see people get better. The results encourage us,” she says.

Thanh spends her days reading, resting in a patient bed and waiting for weekly family visits. When she hears that she might be able to go home soon, her eyes light up.

Her husband has tested negative for TB and soon her young son will be examined. She has gained three kilograms and breathes more easily. The hospital expects that with the current treatment she will soon no longer be infectious.

In general, patients are treated at home or in the community, with outpatient support, as soon as possible.

Viet Nam is committed to a strong national TB programme but international assistance will be critical to maintain what has been established to diagnose and cure these patients and stop further spread of MDR-TB.