Tuberculosis in patients with and without primary health coverage

BACKGROUND: The aim of this study was to determine whether tuberculosis (TB) treatment and follow-up is a feasible option for patients without primary health coverage when free access to health care and drug delivery is provided on an outpatient basis. METHODS: We conducted a retrospective analysis of patient characteristics, treatment modalities, and evolution up to 9 months of follow-up at Saint-Louis Hospital, Paris, France. RESULTS: TB patients without (n=44) compared to those with (n=49) primary health coverage at diagnosis tended to be younger and more frequently homeless (P<0.05) or had illegal status (P<0.001). They had similar TB presentation when starting treatment, but required free drug delivery more often (74 vs. 21%, P<0.001). After the same duration of follow-up, patients considered as cured or as having completed treatment (52.3 vs. 51%), dead (2.3 vs. 8.2%), still under treatment (13.2 vs. 6.1%), or lost to follow-up (31.8 vs. 34.7%) were similar in both groups. At the end of the follow-up period, 43% of the patients without primary health coverage had managed to obtain 70% or 100% free medical aid or social security. CONCLUSIONS: Free access to health care and drug delivery is worthwhile in TB patients without primary health coverage since it permits the same clinical results as in TB patients with primary health coverage. However, efforts should be made to improve the management and follow-up of TB patients and to lower the number of patients lost to follow-up, whatever their social status.