Title: Tuberculosis treatment outcome monitoring in Europe – time to update
recommendations?
Authors: Falzon D*, Scholten J**, Infuso A*.
Affiliation: * EuroTB, Department of
infectious diseases, Institut de veille sanitaire,
12 rue du Val d’Osne, 94415
Saint-Maurice CEDEX, France.
** WHO Regional Office for Europe, 8 Scherfigsvej,
2100 Copenhagen, Denmark
Corresponding Author:
Dennis FALZON (address as above)
Tel +33 141796805
Fax +33 141796802
Email: eurotb@invs.sante.fr
Background: Treatment outcome monitoring (TOM) in Europe is based on WHO/UNION
recommendations from 1998. We discuss
the adherence of European countries to modifications to enhance international
comparability introduced from 2001 cohorts.
Methods: European countries were
requested to assign outcomes on new and retreated definite (culture or smear
positive) pulmonary tuberculosis cases notified in 2000. Cases were only to be excluded in case of
errors of diagnosis or enumeration.
Numbers of definite cases notified were compared with those included in
TOM to estimate completeness. The
maximal observation period for outcomes was 12 months from start of
treatment/diagnosis. Countries reported
outcomes as ‘cured’, ‘completed’, ‘died’, ‘failed’, ‘defaulted’, ‘transferred’
and ‘other, not evaluated’. In 2001,
cases with unknown treatment history were also to be reported. Two outcome categories – ‘still on
treatment’ (at 12 months) and ‘unknown’ - were added so that all cases could be
evaluated.
Results: The number of countries
submitting complete (>98%), nationwide TOM data increased from 19/51
in 2000 to 32/52 in 2001. In 2001,
eight countries included cases with unknown treatment history. Of 21 countries with information, 12
complied with the recommended observation period and 15 with outcome
categories. Among new cases, ‘still on
treatment’ was commoner in the European Union (EU) &
West (median: 1%, country range 0-15%) than in the Centre and East (0%;
0-9%). ‘Unknown’
was used by 19 countries (1%; 0%-30%). Cases were more frequently classified ‘transferred’ or
‘defaulted’ in countries where ‘unknown’ was low. ‘Failed’ was rarely used in the EU
& West compared to the East (0% vs 8%).
Conclusions: TOM cohorts should be complete,
including all definite tuberculosis cases notified. The 12-month period of observation needs to
be adopted more widely. Multi-drug
resistant cases on treatment at 12-months should be followed-up longer. The
‘still on treatment’ and ‘unknown’ categories should be retained.
Keywords:
tuberculosis; Europe; treatment outcome; definitions.