Tuberculosis Information Management System Research Articles

Non-adherence and drug-related interruptions are risk factors for delays in completion of treatment for tuberculosis

A key program performance objective established by the Centers for Disease Control and Prevention (CDC) is that ≥93% of tuberculosis (TB) cases complete treatment within 12 months. To determine the rate of and risk factors for delay in anti-tuberculosis treatment completion. Nested case-control study among TB cases reported to the Tennessee Department of Health between 1 January 2000 and 31 December 2010. Time to complete treatment was calculated using treatment start and stop dates documented in the Tuberculosis Information Management System (TIMS). Of 2627 cases, 261 (9.9%) required >12 months to complete treatment. In adjusted conditional logistic regression analyses, cavitary disease and positive cultures after 2 months of therapy (OR 5.85, 95%CI 1.98-17.32, P = 0.001), non-adherence (OR 4.13, 95%CI 1.76-9.72, P < 0.001), and interruptions in treatment due to drug-related issues (OR 6.91, 95%CI 3.76-12.70, P < 0.001) were independently associated with delay in completion of TB treatment. From 2000 to 2010, the proportion of TB cases completing treatment within 12 months increased from 84.6% to 94.9%, and remained above the CDC target during 2009-2010. Efforts to improve patient adherence and reduce interruptions in treatment due to anti-tuberculosis drug-related issues could improve the proportion of TB cases completing treatment within 12 months.

Factors associated with mortality in patients with tuberculosis

BackgroundKnown risk factors for death following a diagnosis of tuberculosis may not be applicable to current U.S. cases. We evaluated the factors associated with all-cause mortality in patients with tuberculosis in Washington State.MethodsUsing data from the Tuberculosis Information Management System of Washington State, we conducted a cohort study of all residents diagnosed with tuberculosis from 1993 through 2005. Death from any cause was ascertained through the Washington State Death Certificate Data Files. Proportional hazards models were used to estimate the independent effect on all-cause mortality of demographic, clinical, and behavioral characteristics.ResultsDuring a median follow-up of 6 years in 3451 patients treated for tuberculosis, there were 417 deaths. Mortality was independently associated with increasing age, male gender, HIV-coinfection, and U.S. birth. Within 1 year of tuberculosis diagnosis, treatment by a private provider and the use of directly observed therapy were also independently associated with increased mortality. In addition, an interaction term of private provider times directly observed therapy was also significantly associated with mortality.ConclusionsWe identified factors independently associated with increased all-cause mortality following a diagnosis of tuberculosis. The associations between mortality and provider type should be evaluated with more thorough adjustment for severity of illness, but suggest important directions for future research.

Serum immunoconglutinin levels in human amyloidosis and myelomatosis.

<h3>Objective</h3> The WHO estimates that almost 40% of patients diagnosed with tuberculosis (TB) are not reported. We implemented this study to assess TB under-reporting and delayed treatment registration in nine counties in China. <h3>Design</h3> A retrospective inventory study (record review). <h3>Setting</h3> Counties were selected using purposive sampling from nine provinces distributed across eastern, central and western regions of China in 2015. <h3>Primary and secondary outcome measures</h3> Under-reporting was calculated as the percentage of patients with TB not reported to TB Information Management System (TBIMS) within 6 months of diagnosis. Delayed registration was estimated as the percentage of reported cases initiating treatment 7 or more days after diagnosis. Multivariable logistic regression and an alpha level of 0.05 were used to examine factors associated with these outcomes. <h3>Results</h3> Of the 5606 patients with TB identified from project health facilities and social insurance systems, 1082 (19.3%) were not reported to TBIMS. Of the 4524 patients successfully reported, 1416 (31.3%) were not registered for treatment within 7 days of diagnosis. Children, TB pleurisy, patients diagnosed in the eastern and central regions and patients with a TB diagnosis recorded in either health facilities or social insurance system—but not both—were statistically more likely to be unreported. Delayed treatment registration was more likely for previously treated patients with TB, patients with negative or unknown sputum results and for patients diagnosed in the eastern region. <h3>Conclusion</h3> Almost one in every five patients diagnosed with TB in this study was unknown to local or national TB control programmes. We recommend strengthening TB data management practices, particularly in the eastern and central regions, and developing specific guidelines for reporting paediatric TB and TB pleurisy. Patient education and follow-up by diagnosing facilities could improve timely treatment registration. Additional studies are needed to assess under-reporting elsewhere in China.