Predictors of failure in timely tuberculosis treatment completion, United States

Int J Tuberc Lung Dis. 2012 Aug;16(8):1075-82. doi: 10.5588/ijtld.11.0814. Epub 2012 Jun 5.

Abstract

Setting: The US tuberculosis (TB) surveillance system.

Objective: To examine failure in timely TB treatment completion to identify interventions toward achieving the national goal of ≥ 93% treatment completion in ≤ 12 months among patients eligible for 6-9 month regimens.

Design: We examined 1993-2006 trends in timely treatment completion; for 2006 cases, we used Poisson regression to assess predictors for failure in timely completion.

Results: Timely treatment completion improved from 64% in 1993 to 84% in 2006, with similar trends among foreign- and US-born persons and racial/ethnic subgroups. Annual increases in timely completion were ≤ 1 percentage point during 1998-2006. Subpopulations at highest risk for failure in timely completion were persons with combined pulmonary and extra-pulmonary disease (foreign-born adjusted RR [aRR] 3.25, 95%CI 2.47-4.28; US-born aRR 2.75, 95%CI 1.98-3.83) or incarceration (foreign-born aRR 2.30, 95%CI 1.80-2.93; US-born aRR 1.71, 95%CI 1.36-2.14). Homelessness and human immunodeficiency virus infection were other risk factors.

Conclusions: Particular attention to timely completion is needed for subpopulations requiring strong medical expertise in TB management and those at risk for treatment non-adherence, especially if foreign-born. Understanding and addressing causes of delayed completion and improving documentation of treatment completion among all cases will be crucial to achieving the US goal.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antitubercular Agents / administration & dosage*
  • Coinfection
  • Comorbidity
  • Directly Observed Therapy
  • Documentation
  • Emigration and Immigration
  • Ethnic Groups
  • Female
  • HIV Infections / epidemiology
  • Homeless Persons
  • Humans
  • Linear Models
  • Male
  • Medication Adherence* / ethnology
  • Middle Aged
  • Multivariate Analysis
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Tuberculosis / diagnosis
  • Tuberculosis / drug therapy*
  • Tuberculosis / ethnology
  • United States / epidemiology
  • Young Adult

Substances

  • Antitubercular Agents