National TB cohort review evaluation: insights for control strategies in low-incidence settings

TB cohort review is a structured clinical audit of case management and epidemiological data. In 2012, Wales (UK) implemented a national cohort review programme to improve clinical outcomes and enhance public health surveillance.

Retrospective population-based cohort analysis of care quality outcomes for all notified TB cases in Wales (2012-2022). Adjusted regression modelling assessed temporal trends post-implementation and compared outcomes of cases presented at TB cohort review with those not presented.

Of the 1,175 notified TB cases over the study period, 985 (83.1%) were presented at cohort review. Many case management outcomes achieved near-target thresholds. Adherence support was increasingly targeted at index cases with social complexity and higher transmission risk, alongside substantial improvements in the completeness of surveillance data. Persistent programmatic challenges in contact identification and assessment were identified.

As countries approach pre-elimination thresholds, TB services must ensure rigorous surveillance data collection and targeting of limited resources to populations at greatest risk of transmission and non-completion of treatment. Since implementing a national TB cohort review in Wales, there have been significant post-implementation improvements in care outcomes. This provides a robust, resource-efficient framework for TB control that could be applied to other similarly resourced low-incidence countries.