Abstract
Tuberculosis (TB) patients who do not complete treatment pose a potential public health risk. In West Yorkshire, local clinicians suspected that this risk was overestimated by the national Enhanced Tuberculosis Surveillance system. We audited patients who failed to complete treatment and were categorised as lost-to-follow-up (LTFU) between 2004 and 2008, using a combination of hand searching existing records and obtaining additional information from clinicians. In the study period 2,031 TB cases with reported outcome were notified in West Yorkshire, 23% (n=474) did not complete treatment, and 199 (42%) of those were categorised as LTFU 12 months after notification. Of these 199, 49% (n=98) remained LTFU after the audit, 51% (n=101) were re-classified to the following categories: 24% (n=47) transferred abroad, 16% (n=31) recommenced and completed treatment, 6% (n=13) transferred to another clinic in the United Kingdom (UK), and 5% (n=10) died. These patients therefore no-longer posed a public health risk. Further training for clinicians to improve accuracy of outcome reporting has been initiated. Nationally, the collection of treatment outcome data needs to be strengthened and extending the follow-up for treatment outcome monitoring should be considered.
Highlights
The most important intervention for the control of tuberculosis (TB) is effective treatment of infectious cases [1]
In West Yorkshire, between 2004 and 2008, more patients successfully completed treatment than existing surveillance data indicated, which implies that the risk to public health from treatment failure may have been over-estimated
Some of this variation in reporting is due to the fact that reporting clinicians did not always select the appropriate option in the reporting form. This could have occurred for two reasons: the first is through classification error where clinicians had access to the correct information regarding the patients’ outcome but completed the wrong section on the Treatment Outcome Monitoring (TOM) form; the second is that the clinician did not have the relevant information to hand at the time of completing the form, which resulted in misclassification
Summary
The most important intervention for the control of tuberculosis (TB) is effective treatment of infectious cases [1]. Treatment success measured by a standardised process of treatment outcome monitoring is one of the pillars of TB control. The World Health Assembly (WHA) passed a resolution in 1991, adopting the target to cure at least 85% of TB cases as one of two global targets [2]. In the European Union (EU), TB case notification rates are among the lowest in the world, declining by 15.2% between 2005 and 2010 [3]. There was a concurrent decline in treatment completion rates in the region, declining from 72.5% in 2005 to 68.7% in 2010 among new diagnosed cases, the lowest TB treatment success rate in the world and short of the WHA resolution target [3].
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