PeerLINC webinar highlights early monitoring of adverse events in DR-TB care

Healthcare professionals from many countries joined the first PeerLINC Webinar Series session on 15 September 2026 for a practical discussion on recognizing and managing adverse events during drug-resistant tuberculosis treatment.

The session focused on peripheral neuropathy and optic neuritis, with presentations from Dr. Alberto Piubello, a member of the Global Technical Expert Council (G-TEC), and Dr. Irene Flores, G-TEC Lead. Expert presentations were complemented by clinical cases, participant polls, and demonstrations intended to help healthcare teams apply adverse-event monitoring in drug-resistant tuberculosis (DR-TB) facilities.

Dr. Piubello, Medical Advisor for the Damien Foundation and an MDR-TB expert at the Institute of Tropical Medicine Antwerp, opened the technical discussion with a presentation on peripheral neuropathy.

He explained the different mechanisms through which medicines used in DR-TB treatment, including linezolid, cycloserine, and isoniazid, may affect peripheral nerves. He also discussed the clinical considerations involved in deciding whether treatment should be continued, adjusted, or discontinued when peripheral neuropathy is suspected.

According to Dr. Piubello, monitoring should not rely solely on symptoms reported by patients, as this may delay recognition of important signals. Routine clinical assessment throughout treatment is therefore essential to identify issues before they become severe enough for patients to report.

“We should not rely on symptoms because people have the tendency to reduce linezolid from 600 to 300 just based on symptoms. It may be too late. … The main tests are very easy to perform and can be performed at the DR-TB facility, in the interest of patients, to take the right decision at the right time,” Dr. Piubello said.

His presentation demonstrated how monofilaments, tuning forks, pinprick testing, and temperature-sensation assessments can help healthcare workers identify possible changes in nerve function. These tests can support early recognition and appropriate referral, particularly in settings where neurological services are not consistently available.

Dr. Flores, Senior Clinical Advisor at PeerLINC and the Philippines’ Principal Investigator for the multi-country BPaL Operational Research, followed with a presentation on optic neuritis and the role of baseline and follow-up assessments in monitoring changes in vision during DR-TB treatment.

She explained that patients may not immediately recognize or report gradual changes, particularly when they retain enough peripheral vision to continue their usual activities. Establishing a baseline before treatment allows healthcare workers to distinguish new changes from pre-existing visual conditions and assess how results develop over time.

“Baseline eye evaluation tells us what was present before treatment. It can identify, for example, red-green color vision deficiency, color blindness, cataracts, refractive errors, and other pre-existing issues that could affect later test results. Baseline visual-acuity and color-vision screening help determine whether treatment can be started and monitored safely, and it also gives us a reference point. A meaningful change during follow-up is easier to recognize,” Dr. Flores said.

The session presented visual-acuity and color-vision testing as practical components of continued patient monitoring. A demonstration video showed how healthcare workers can perform and document a visual-acuity assessment using a Snellen chart, including adaptations that may be used in facilities with limited space.

Both presentations were followed by clinical case exercises in which participants considered assessment findings, the timing and severity of adverse events, and the patient’s stage of treatment before selecting an appropriate response. The discussions highlighted that adverse-event management should not be reduced to an automatic change in dosage but should be guided by clinical findings and the circumstances of each patient.

The session forms part of PeerLINC’s broader work to support the implementation of new DR-TB treatments through clinical training, technical assistance, and peer-to-peer learning. It also provided an avenue for G-TEC members to share clinical and programmatic expertise with healthcare professionals beyond the council.