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CMAJ. Mar 23, 1999; 160(6): 789–794.
PMCID: PMC1230157

Outcome of pulmonary tuberculosis treatment in the tertiary care setting -- Toronto 1992/93

Abstract

BACKGROUND: Completion of treatment of active cases of tuberculosis (TB) is the most important priority of TB control programs. This study was carried out to assess treatment completion for active cases of pulmonary TB in Toronto. METHODS: Consecutive cases of culture-proven pulmonary TB were obtained from the microbiology laboratories of 5 university-affiliated tertiary care centres in Toronto in 1992/93. A standard data-collection tool was used to abstract information from inpatient and outpatient charts. For patients who were transferred to other treatment centres or lost to follow-up, the local health unit was contacted for information about treatment completion. If incomplete information was obtained from these sources, data from the provincial Reportable Disease Information System were also reviewed. The main outcome analysed was treatment outcome, with cases classified as completed (record of treatment completion noted), transferred (patient transferred to another centre but no treatment results available), defaulted (record of defaulting in patient chart but no record of treatment completion elsewhere, or patient still receiving treatment more than 15 months after diagnosis) or dead (patient died before treatment completion). RESULTS: Of the 145 patients 84 (58%) completed treatment, 25 (17%) died, 22 (15%) defaulted and 14 (10%) were transferred. The corresponding values for the 22 patients with HIV coinfection were 6 (27%), 5 (23%), 8 (36%) and 3 (14%). Independent predictors of failure to complete treatment were injection drug use (adjusted odds ratio [OR] 5.7, 95% confidence interval [CI] 1.5 to 22.0), HIV infection (adjusted OR 4.6, 95% CI 1.4 to 14.7) and adverse drug reaction (adjusted OR 2.9, 95% CI 1.1 to 7.9). Independent predictors of death included age more than 50 years (adjusted OR 16.7, 95% CI 2.6 to 105.1), HIV infection (adjusted OR 16.1, 95% CI 3.9 to 66.4), immunosuppressive therapy (adjusted OR 8.0, 95% CI 1.9 to 34.4) and infection with a multidrug-resistant organism (adjusted OR 30.7, 95% CI 1.5 to 623.0). INTERPRETATION: Treatment completion rates in tertiary care hospitals in Toronto in 1992/93 were below the rate recommended by the World Health Organization. Careful surveillance of treatment completion is necessary for the management of TB in metropolitan centres in Canada.

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Selected References

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  • Menzies R, Rocher I, Vissandjee B. Factors associated with compliance in treatment of tuberculosis. Tuber Lung Dis. 1993 Feb;74(1):32–37. [PubMed]
  • Sumartojo E. When tuberculosis treatment fails. A social behavioral account of patient adherence. Am Rev Respir Dis. 1993 May;147(5):1311–1320. [PubMed]
  • Brudney K, Dobkin J. Resurgent tuberculosis in New York City. Human immunodeficiency virus, homelessness, and the decline of tuberculosis control programs. Am Rev Respir Dis. 1991 Oct;144(4):745–749. [PubMed]
  • Slutkin G. Management of tuberculosis in urban homeless indigents. Public Health Rep. 1986 Sep-Oct;101(5):481–485. [PMC free article] [PubMed]
  • Fujiwara PI, Larkin C, Frieden TR. Directly observed therapy in New York City. History, implementation, results, and challenges. Clin Chest Med. 1997 Mar;18(1):135–148. [PubMed]
  • Schluger N, Ciotoli C, Cohen D, Johnson H, Rom WN. Comprehensive tuberculosis control for patients at high risk for noncompliance. Am J Respir Crit Care Med. 1995 May;151(5):1486–1490. [PubMed]
  • Hopewell PC. Impact of human immunodeficiency virus infection on the epidemiology, clinical features, management, and control of tuberculosis. Clin Infect Dis. 1992 Sep;15(3):540–547. [PubMed]
  • Onorato IM, McCray E. Prevalence of human immunodeficiency virus infection among patients attending tuberculosis clinics in the United States. J Infect Dis. 1992 Jan;165(1):87–92. [PubMed]
  • Barnes PF, Silva C, Otaya M. Testing for human immunodeficiency virus infection in patients with tuberculosis. Am J Respir Crit Care Med. 1996 Apr;153(4 Pt 1):1448–1450. [PubMed]
  • Chaulk CP, Moore-Rice K, Rizzo R, Chaisson RE. Eleven years of community-based directly observed therapy for tuberculosis. JAMA. 1995 Sep 27;274(12):945–951. [PubMed]
  • Burman WJ, Dalton CB, Cohn DL, Butler JR, Reves RR. A cost-effectiveness analysis of directly observed therapy vs self-administered therapy for treatment of tuberculosis. Chest. 1997 Jul;112(1):63–70. [PubMed]
  • Moore RD, Chaulk CP, Griffiths R, Cavalcante S, Chaisson RE. Cost-effectiveness of directly observed versus self-administered therapy for tuberculosis. Am J Respir Crit Care Med. 1996 Oct;154(4 Pt 1):1013–1019. [PubMed]
  • Weis SE, Slocum PC, Blais FX, King B, Nunn M, Matney GB, Gomez E, Foresman BH. The effect of directly observed therapy on the rates of drug resistance and relapse in tuberculosis. N Engl J Med. 1994 Apr 28;330(17):1179–1184. [PubMed]
  • Iseman MD, Cohn DL, Sbarbaro JA. Directly observed treatment of tuberculosis. We can't afford not to try it. N Engl J Med. 1993 Feb 25;328(8):576–578. [PubMed]
  • Mahmoudi A, Iseman MD. Pitfalls in the care of patients with tuberculosis. Common errors and their association with the acquisition of drug resistance. JAMA. 1993 Jul 7;270(1):65–68. [PubMed]

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