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Treatment Outcomes of Patients with Tuberculosis in New York City
Darlene Bhavnani1, Nicola Lancki, Iris Winter
1New York City Department of Health and Mental Hygiene, New York (Drs Bhavnani and Macaraig and Mss Lancki and Winter); and Centers for Disease Control and Prevention, Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship, Atlanta, Georgia (Dr Bhavnani and Ms Lancki).
Context:
Treatment completion for tuberculosis (TB) is one of the essential components of TB prevention and control. Delays in treatment completion and incomplete treatment can result in increased transmission, development of drug resistance, and increased morbidity and mortality. Understanding the reasons for poor treatment outcomes may help improve TB control efforts.
Objective:
To identify those at highest risk and determine the reasons for poor treatment outcomes among TB cases (January 2009-June 2010).
Design:
Retrospective analysis.
Setting/Participants:
New York City TB patients eligible to complete treatment within 12 months.
Main Outcome Measures:
Poisson regression models were used to identify risk factors associated with delayed completion and incomplete treatment compared with completion within 12 months of initiating treatment (timely completion). Reasons for delayed completion and incomplete treatment were summarized.
Results:
Of 1008 cases eligible to complete treatment within 12 months, 921 (91%) had timely completion, 48 (5%) had delayed completion, and 39 (4%) had incomplete treatment. Cases with delayed completion and incomplete treatment were more likely to have extrapulmonary TB (adjusted risk ratio = 3.31; 95% confidence interval, 1.79-6.14; and adjusted risk ratio = 3.34; 95% confidence interval, 1.73-6.44, respectively). Primary reasons for delayed completion were a physician's decision to extend treatment (35%) and interrupted treatment (31%), whereas those for incomplete treatment included lost to care (38%), moved (28%), and refusal to continue treatment (26%).
Conclusion:
Overall, treatment completion in New York City was high. Patients with delayed completion and incomplete treatment had extrapulmonary disease in common. However, specific reasons suggest that delayed completion may be clinically motivated whereas incomplete treatment may result from social conditions.
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