Title: Outcome of tuberculosis cases in Europe, 2000-2001: exploring determinants of success.
Authors: Falzon D, Belghiti
F, Infuso A.
Affiliation: EuroTB, Infectious
diseases dept., Institut de Veille Sanitaire,
12 rue du Val d’Osne,
94415 Saint-Maurice CEDEX, France.
Corresponding
Author:
Dennis
FALZON (address as above)
Tel +33
141796805
Fax +33
141796802
Email:
eurotb@invs.sante.fr
Background: treatment outcome monitoring (TOM) is an essential tool to assess the performance of TB control programmes. Analysis of aggregate data limits the possibility to understand reasons for not reaching global targets. We performed a study to assess the feasibility of collecting TOM data at individual level in Europe and to describe outcome determinants.
Methods: In March 2003, we requested the European countries already
providing individual data on notified TB cases to code outcomes for all cases
notified in 2000 and/or 2001. A
multivariate logistic regression model including country of report was used to
explain success in cases with positive culture and data on susceptibility to
isoniazid, rifampicin and ethambutol at the start of treatment.
Results: Thirteen countries participated (Austria, Belgium, Czech Republic, Estonia, Germany, Hungary, Iceland, Malta, Netherlands, Norway, Romania, Slovakia and Slovenia). Owing to definitional inconsistencies, Romania (23,885 cases) was excluded from analysis which were performed on the remaining 23,567 TB cases. Success was reported in 66% of the cases (country range: 54-88%), death in 9% (0-11%) and unknown outcome in 15% of the cases (0-26%). Failure, default and transfer accounted for 5% of cases (range: 2-15%). At logistic regression (N=10,323 cases), success was associated with being young (reference >64 years); 45-64y: OR=1.7 [CI95%: 1.5-1.9]; 15-44y: 2.2 [2.0-2.5]; <15y: 2.7 [1.9-3.9]); female (1.4 [1.2-1.5]); without history of previous anti-TB treatment (1.4 [1.2-1.7]); and fully susceptible to antibiotics (3.6 [3.0-4.2]). Success was not associated with foreign origin or pulmonary disease. Country ranking in success mirrored that in univariate analysis.
Conclusions: The collection of individual TOM data at the
European level is practicable and provides useful insights into determinants of
success. The residual differences in
success between countries after adjustment might be due to differences in data
completeness as well as variations in the effectiveness of control programmes.
Keywords:
tuberculosis; Europe; treatment outcome; treatment success; EuroTB