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Monitoring tuberculosis treatment outcome: analysis of national surveillance data from a clinical perspective
  1. Ivo Che Ditah
  1. Institute of Public Health, University of Cambridge, United Kingdom
    1. Mark Reacher
    1. Health Protection Agency, Regional Epidemiology Unit (East of England), United Kingdom
      1. Chris Palmer
      1. Institute of Public Health, University of Cambridge, United Kingdom
        1. John M Watson
        1. Health Protection Agency Centre for Infections, United Kingdom
          1. John Innes
          1. Birmingham Heartlands Hospital, Birmingham, United Kingdom
            1. Michelle E Kruijshaar
            1. Health Protection Agency Centre for Infections, United Kingdom
              1. Henry N Luma
              1. Faculty of Medicine and Biomedical Sciences, Yaounde-Cameroon, United Kingdom
                1. Ibrahim Abubakar (ibrahim.abubakar{at}hpa.org.uk)
                1. Health Protection Agency, United Kingdom

                  Abstract

                  Background: In 1998, the World Health Organisation (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD) published recommendations standardising the evaluation of tuberculosis treatment outcome in Europe. These guidelines fail to account for clinically appropriate alterations in the management of patients.

                  Objectives: To evaluate tuberculosis treatment outcome in England, Wales and Northern Ireland by re-defining the outcome criteria and investigate factors associated with unsuccessful treatment outcome 12 months after notification.

                  Methods: This was a prospective analysis of a cohort of patients diagnosed in England, Wales and Northern Ireland and reported to the Enhanced Tuberculosis Surveillance system in 2001 and 2002. Proportions of success and failure were calculated based on a new set of criteria following discussion with clinicians treating tuberculosis cases. Logistic regression was used to study risk factors for unsuccessful treatment outcome.

                  Results: A total of 13,048 cases were notified in the study period. Of the 2,676 that were identified as new sputum smear-positive pulmonary cases, 2,209(82.5%) had treatment outcome data reported. Using the WHO/IUATLD criteria, 76.8% were classified as successful. In contrast, applying the new criteria, the success rate was 87.5%. This rate exceeds the 85% success target set by the WHO. Risk factors for unsuccessful treatment outcome included male sex (OR 1.27; 95%CI 1.08-1.49), being elderly (P-trend <0.001), having pulmonary tuberculosis (OR 1.28; 95%CI 1.08-1.53), and having resistance to any anti-tuberculosis drug (OR 1.90; 95%CI 1.44-2.52).

                  Conclusion: The proportion of tuberculosis cases with a successful treatment outcome exceeded the target of 85% success rate based on the modified outcome categories. Although the tuberculosis treatment outcome criteria set by WHO/IUATLD appear to be clear, they mix measures of process and outcome. Further refinement may be necessary in low-incidence high-income countries, especially those with a high mortality among the elderly.

                  • Mycobacterium tuberculosis
                  • Outcome measures
                  • Treatment
                  • Tuberculosis

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