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Progress and problems in achieving the United States national target for completion of antituberculosis treatment
D P Chin1, K C Cummings, S Sciortino
1Tuberculosis Control Branch and Disease Investigations and Surveillance Branch, Division of Communicable Diseases, California Department of Health Services, Berkeley, USA.
Setting:
The target for antituberculosis treatment in the United States is for 90% of patients to complete therapy within 12 months.
Objective:
To assess progress in achieving the US national target for tuberculosis treatment.
Design:
A comparison of treatment outcome in two cohorts of patients with drug-susceptible tuberculosis in California-those reported in 1993-1994 (8488 patients) and 1995-1996 (7823 patients). Risk factors for delay in treatment completion (more than 12 months) were assessed.
Results:
The percentage of cases completing treatment within 12 months increased in the 1995-1996 cohort (to 68.2%), primarily due to concomitant reductions in delays in treatment completion (to 11.1%) and defaulting (to 2.4%). Disparities in timely treatment completion narrowed over time and in nearly all subpopulations, especially in groups with lowest treatment completion in the 1993-1994 cohort. Remaining risk factors for delay in treatment completion included AIDS and older ages. A substantial percentage of patients died or moved before treatment completion.
Conclusions:
Despite recent improvements, completion of antituberculosis treatment in California has not reached the national target. Reaching this target will require further reductions in delays in treatment completion and deaths during treatment, and ensuring that patients who move eventually complete treatment.