PhD ceremony Mr. Vu Dinh Hoa: Clinical pharmacology of tuberculosis drugs and tuberculosis control in developing world. The involvement of private pharmacy and the individualization of treatment using dried blood spot

PhD ceremony: Mr. Vu Dinh Hoa, 11.00 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Clinical pharmacology of tuberculosis drugs and tuberculosis control in developing world. The involvement of private pharmacy and the individualization of treatment using dried blood spot

Promotor(s): prof. J.R.B.J. Brouwers, prof. D.R.A. Uges, prof. D.H. Nguyen

Faculty: Mathematics and Natural Sciences

The research of Dinh Hoa Vu emphasized the clinical pharmacology aspects related to Tuberculosis (TB) control in the developing world, where TB epidemics are serious and complex. Worldwide there is an alarming increase in multidrug- resistant tuberculosis (MDR-TB). This increase is now emerging from Eastern Europe and Central Asia. So to attack TB we need: knowledge by the healthcare workers and easy tests for individual monitoring of TB therapy.

Vu performed a field study using a simulated patient method and interview, to explore the TB control activities and knowledge of healthcare providers (HCPs) in private pharmacies in Hanoi, Vietnam. It was common that HCPs did not refer suspected tuberculosis patients and advised to dispense rifampicin and fluoroquinolone for the suspected case. This may contribute to worsening the epidemic and emergence of drug resistance. Postgraduate teaching for pharmacists in TB control is urgently needed.

Vu developed new and simple methods for monitoring anti-TB drugs in blood, which can be applied to treatment optimization and adherence control. Only one drop of blood, drawn by a fingerprick, is needed for analysis. The new method is called Dried Blood Spot Method (DBS). The patient variation in blood levels of the anti-TB drugs is variable because of differences in genetics, bodyweight, race etc... The development of the DBS for easily implementing therapeutic drug monitoring for MDR-TB in the developing world is urgently needed. We developed analytical methods for the anti-TB-drugs: moxifloxacin, linezolid, rifampicin and clarithromycin. We figured out technical and clinical aspects of the DBS analytical method which supports the application of this tool in a clinical environment. The opportunity to apply DBS to TB control in developing (poor) countries from the perspective of Good Global Health for all people, is discussed.