From trials to programmatic scale-up: treatment outcomes of rifampicin-resistant tuberculosis during transition to short oral regimens in Vietnam (2021-2022)

Thi Mai Phuong Nguyen; Van Luong Dinh; Binh Hoa Nguyen; Thi Thanh Thuy Hoang; Viet Nhung Nguyen; Steven Callens; Tom Decroo

doi:10.1016/j.ijid.2025.108222

From trials to programmatic scale-up: treatment outcomes of rifampicin-resistant tuberculosis during transition to short oral regimens in Vietnam (2021-2022)

Thi Mai Phuong Nguyen, Van Luong Dinh, Binh Hoa Nguyen, Thi Thanh Thuy Hoang, Viet Nhung Nguyen, Steven Callens, Tom Decroo

Research output: Contribution to journal › A1: Web of Science-article › peer-review

Abstract

Highlights
• Rifampicin-resistant tuberculosis regimens from injectable to all-oral.
• Nationwide outcome during transition.

Abstract

Objectives
Vietnam is a high tuberculosis (TB) and rifampicin-resistant TB (RR-TB) burden country. Different new RR-TB regimens were recommended in recent years. Locally-generated evidence about nationwide implementation of different RR-TB regimens is essential to inform national treatment guidelines.

Methods
A retrospective cohort study of all patients with RR-TB treated nationwide in Vietnam from 2021 to 2022. Short treatment regimens (STR) were 9-11-month standardized 7-drug regimens with either bedaquiline (BDQ_STR) or an injectable drug (inj_STR), and a modified 9-11-month 5-drug regimen (m_STR). Long regimens were 18-20-month regimens for fluoroquinolone-susceptible RR-TB (long RR-TB) or fluoroquinolone-resistant RR-TB (long pre-extensively drug-resistant TB). With logistic regression we estimated predictors of unfavorable outcome.

Results
Of 4814 patients with RR-TB, 71.2% had end-of-treatment success. Failure, death, lost-to-follow-up (LTFU) and not evaluated accounted for 3.6%, 7.8%, 13.3%, and 4.2%, respectively. Long RR-TB regimen had significantly higher unfavorable outcomes as compared to BDQ_STR (adjusted odds ratio [95% confidence interval] = 1.56 [1.32-1.84]). Among STR, inj_STR had the lowest success rate (71.8%) in comparison to BDQ_STR (76.2%) (adjusted odds ratio [95% confidence interval] = 1.23 [1.04-1.45]). However, the LTFU rate is still high in both BDQ_STR and inj_STR. Treatment with inj_STR or long RR-TB regimen, retreatment after LTFU, being male and aged ≥50 years were predictors of unfavorable RR-TB treatment outcomes.

Conclusions
During the transition from injectable-containing to all-oral short regimens, nationwide data showed 71.2% RR-TB treatment success in Vietnam. The wider use of STRs and addressing LTFU may further improve outcomes. More robust and better managed long regimens are needed for those not eligible for any STR.

Original language	English
Article number	108222
Journal	International Journal of Infectious Diseases
Volume	163
Number of pages	7
ISSN	1201-9712
DOIs	https://doi.org/10.1016/j.ijid.2025.108222
Publication status	E-pub ahead of print - 13-Nov-2025

Keywords

All-oral regimen
Drug-resistant tuberculosis
Shorter regimen

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Cite this

Nguyen, T. M. P., Dinh, V. L., Nguyen, B. H., Hoang, T. T. T., Nguyen, V. N., Callens, S., & Decroo, T. (2026). From trials to programmatic scale-up: treatment outcomes of rifampicin-resistant tuberculosis during transition to short oral regimens in Vietnam (2021-2022). International Journal of Infectious Diseases, 163, Article 108222. Advance online publication. https://doi.org/10.1016/j.ijid.2025.108222

@article{2c6fb83f75e040a2b078ff428fc9c945,

title = "From trials to programmatic scale-up: treatment outcomes of rifampicin-resistant tuberculosis during transition to short oral regimens in Vietnam (2021-2022)",

abstract = "Highlights • Rifampicin-resistant tuberculosis regimens from injectable to all-oral. • Nationwide outcome during transition. Abstract Objectives Vietnam is a high tuberculosis (TB) and rifampicin-resistant TB (RR-TB) burden country. Different new RR-TB regimens were recommended in recent years. Locally-generated evidence about nationwide implementation of different RR-TB regimens is essential to inform national treatment guidelines. Methods A retrospective cohort study of all patients with RR-TB treated nationwide in Vietnam from 2021 to 2022. Short treatment regimens (STR) were 9-11-month standardized 7-drug regimens with either bedaquiline (BDQ\_STR) or an injectable drug (inj\_STR), and a modified 9-11-month 5-drug regimen (m\_STR). Long regimens were 18-20-month regimens for fluoroquinolone-susceptible RR-TB (long RR-TB) or fluoroquinolone-resistant RR-TB (long pre-extensively drug-resistant TB). With logistic regression we estimated predictors of unfavorable outcome. Results Of 4814 patients with RR-TB, 71.2\% had end-of-treatment success. Failure, death, lost-to-follow-up (LTFU) and not evaluated accounted for 3.6\%, 7.8\%, 13.3\%, and 4.2\%, respectively. Long RR-TB regimen had significantly higher unfavorable outcomes as compared to BDQ\_STR (adjusted odds ratio [95\% confidence interval] = 1.56 [1.32-1.84]). Among STR, inj\_STR had the lowest success rate (71.8\%) in comparison to BDQ\_STR (76.2\%) (adjusted odds ratio [95\% confidence interval] = 1.23 [1.04-1.45]). However, the LTFU rate is still high in both BDQ\_STR and inj\_STR. Treatment with inj\_STR or long RR-TB regimen, retreatment after LTFU, being male and aged ≥50 years were predictors of unfavorable RR-TB treatment outcomes. Conclusions During the transition from injectable-containing to all-oral short regimens, nationwide data showed 71.2\% RR-TB treatment success in Vietnam. The wider use of STRs and addressing LTFU may further improve outcomes. More robust and better managed long regimens are needed for those not eligible for any STR.",

keywords = "All-oral regimen, Drug-resistant tuberculosis, Shorter regimen",

author = "Nguyen, \{Thi Mai Phuong\} and Dinh, \{Van Luong\} and Nguyen, \{Binh Hoa\} and Hoang, \{Thi Thanh Thuy\} and Nguyen, \{Viet Nhung\} and Steven Callens and Tom Decroo",

year = "2025",

month = nov,

day = "13",

doi = "10.1016/j.ijid.2025.108222",

language = "English",

volume = "163",

journal = "International Journal of Infectious Diseases",

issn = "1201-9712",

publisher = "Elsevier",

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From trials to programmatic scale-up: treatment outcomes of rifampicin-resistant tuberculosis during transition to short oral regimens in Vietnam (2021-2022). / Nguyen, Thi Mai Phuong; Dinh, Van Luong; Nguyen, Binh Hoa et al.
In: International Journal of Infectious Diseases, Vol. 163, 108222, 02.2026.

Research output: Contribution to journal › A1: Web of Science-article › peer-review

TY - JOUR

T1 - From trials to programmatic scale-up: treatment outcomes of rifampicin-resistant tuberculosis during transition to short oral regimens in Vietnam (2021-2022)

AU - Nguyen, Thi Mai Phuong

AU - Dinh, Van Luong

AU - Nguyen, Binh Hoa

AU - Hoang, Thi Thanh Thuy

AU - Nguyen, Viet Nhung

AU - Callens, Steven

AU - Decroo, Tom

PY - 2025/11/13

Y1 - 2025/11/13

N2 - Highlights • Rifampicin-resistant tuberculosis regimens from injectable to all-oral. • Nationwide outcome during transition. Abstract Objectives Vietnam is a high tuberculosis (TB) and rifampicin-resistant TB (RR-TB) burden country. Different new RR-TB regimens were recommended in recent years. Locally-generated evidence about nationwide implementation of different RR-TB regimens is essential to inform national treatment guidelines. Methods A retrospective cohort study of all patients with RR-TB treated nationwide in Vietnam from 2021 to 2022. Short treatment regimens (STR) were 9-11-month standardized 7-drug regimens with either bedaquiline (BDQ_STR) or an injectable drug (inj_STR), and a modified 9-11-month 5-drug regimen (m_STR). Long regimens were 18-20-month regimens for fluoroquinolone-susceptible RR-TB (long RR-TB) or fluoroquinolone-resistant RR-TB (long pre-extensively drug-resistant TB). With logistic regression we estimated predictors of unfavorable outcome. Results Of 4814 patients with RR-TB, 71.2% had end-of-treatment success. Failure, death, lost-to-follow-up (LTFU) and not evaluated accounted for 3.6%, 7.8%, 13.3%, and 4.2%, respectively. Long RR-TB regimen had significantly higher unfavorable outcomes as compared to BDQ_STR (adjusted odds ratio [95% confidence interval] = 1.56 [1.32-1.84]). Among STR, inj_STR had the lowest success rate (71.8%) in comparison to BDQ_STR (76.2%) (adjusted odds ratio [95% confidence interval] = 1.23 [1.04-1.45]). However, the LTFU rate is still high in both BDQ_STR and inj_STR. Treatment with inj_STR or long RR-TB regimen, retreatment after LTFU, being male and aged ≥50 years were predictors of unfavorable RR-TB treatment outcomes. Conclusions During the transition from injectable-containing to all-oral short regimens, nationwide data showed 71.2% RR-TB treatment success in Vietnam. The wider use of STRs and addressing LTFU may further improve outcomes. More robust and better managed long regimens are needed for those not eligible for any STR.

AB - Highlights • Rifampicin-resistant tuberculosis regimens from injectable to all-oral. • Nationwide outcome during transition. Abstract Objectives Vietnam is a high tuberculosis (TB) and rifampicin-resistant TB (RR-TB) burden country. Different new RR-TB regimens were recommended in recent years. Locally-generated evidence about nationwide implementation of different RR-TB regimens is essential to inform national treatment guidelines. Methods A retrospective cohort study of all patients with RR-TB treated nationwide in Vietnam from 2021 to 2022. Short treatment regimens (STR) were 9-11-month standardized 7-drug regimens with either bedaquiline (BDQ_STR) or an injectable drug (inj_STR), and a modified 9-11-month 5-drug regimen (m_STR). Long regimens were 18-20-month regimens for fluoroquinolone-susceptible RR-TB (long RR-TB) or fluoroquinolone-resistant RR-TB (long pre-extensively drug-resistant TB). With logistic regression we estimated predictors of unfavorable outcome. Results Of 4814 patients with RR-TB, 71.2% had end-of-treatment success. Failure, death, lost-to-follow-up (LTFU) and not evaluated accounted for 3.6%, 7.8%, 13.3%, and 4.2%, respectively. Long RR-TB regimen had significantly higher unfavorable outcomes as compared to BDQ_STR (adjusted odds ratio [95% confidence interval] = 1.56 [1.32-1.84]). Among STR, inj_STR had the lowest success rate (71.8%) in comparison to BDQ_STR (76.2%) (adjusted odds ratio [95% confidence interval] = 1.23 [1.04-1.45]). However, the LTFU rate is still high in both BDQ_STR and inj_STR. Treatment with inj_STR or long RR-TB regimen, retreatment after LTFU, being male and aged ≥50 years were predictors of unfavorable RR-TB treatment outcomes. Conclusions During the transition from injectable-containing to all-oral short regimens, nationwide data showed 71.2% RR-TB treatment success in Vietnam. The wider use of STRs and addressing LTFU may further improve outcomes. More robust and better managed long regimens are needed for those not eligible for any STR.

KW - All-oral regimen

KW - Drug-resistant tuberculosis

KW - Shorter regimen

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DO - 10.1016/j.ijid.2025.108222

M3 - A1: Web of Science-article

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SN - 1201-9712

VL - 163

JO - International Journal of Infectious Diseases

JF - International Journal of Infectious Diseases

M1 - 108222

ER -

From trials to programmatic scale-up: treatment outcomes of rifampicin-resistant tuberculosis during transition to short oral regimens in Vietnam (2021-2022)

Abstract

Keywords

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