Impact of a TB Team on TB Outcomes: A 2016-2024 Pre-Post Study From a Referral Center in Southern Italy

Tuberculosis (TB) remains a major global public health challenge, requiring innovative management strategies to improve patient outcomes and reduce disease burden. Despite advancements in diagnostics and treatment, TB continues to cause significant morbidity and mortality worldwide, particularly among vulnerable populations such as migrants and individuals with limited healthcare access. The World Health Organization has emphasized the need for patient-centered approaches, including the establishment of TB-dedicated teams, to enhance care coordination and improve outcomes. However, real-world evidence on their effectiveness remains limited.

We conducted a retrospective before-after study to evaluate the impact of a structured TB-dedicated team implemented at a referral hospital in Southern Italy between 2016 and 2024. Prior to 2020, TB care was unstructured, with patients being followed by different physicians without a standardized system. Between 2021 and 2024, a dedicated TB team was established, comprising 2 infectious disease specialists, infectious disease residents, and a senior professor overseeing scientific activities. This new model introduced key interventions, including a dedicated outpatient reservation system, directly observed therapy, structured follow-up, specialist networking, systematic data collection, and targeted counseling on risk behaviors and comorbidities. Primary outcomes included treatment success rates, hospital length of stay, incidence of adverse events, and patient retention in follow-up programs. All tests were 2-sided and a P-value <.05 was considered statistically significant. Statistical analysis was carried out using R 4.4.

A total of 269 TB patients were analyzed (117 pre- and 152 postimplementation). The introduction of the TB team was associated with a significant reduction in loss to follow-up (41.9% to 3.7%; P < .0001; odds ratio, 0.04; 95% confidence interval, .01-.12) and incomplete treatments (41.9% to 12.0; P < .0001; odds ratio, 0.13; 95% confidence interval, .06-.29). Median hospital stay decreased from 28 to 14 days (P < .0001), whereas adverse events remained comparable (32.5% vs 29.6%, P = .71).

The implementation of a TB-dedicated team significantly improved TB management by enhancing treatment adherence, reducing hospitalization, and preventing loss to follow-up. Given the public health impact of TB, structured care models should be prioritized to optimize patient outcomes and strengthen health system efficiency.