Treatment outcomes for drug-sensitive tuberculosis cases reported in France, 2008–2014.
The monitoring of treatment outcomes for patients with active tuberculosis, which was incorporated into the mandatory reporting system (DO) in France in July 2007, is a key component of tuberculosis control. It allows for the identification of cases that have completed treatment and are considered cured, as well as cases that have not completed treatment and which, if infectious, may continue to transmit the infection in the community. In this article, we present the national results of this surveillance since the introduction of mandatory reporting of treatment outcomes, specifically for cases of active tuberculosis reported between 2008 and 2014. Patients were classified according to their status within 12 months of treatment initiation based on European definitions. Tuberculosis cases identified as multidrug-resistant (MDR) in the DO were excluded. Information on treatment outcomes was available for 65% of cases, with an improvement in data reporting between 2008 (60%) and 2014 (72%) (p<0.001). The percentage of departments not providing information was 9% in 2008 and 3% in 2014. During this period, 74.1% of tuberculosis cases, across all clinical forms, completed treatment, with this proportion improving significantly over time (rising from 73.0% in 2008 to 76.9% in 2014, p<0.001). Among pulmonary cases, the proportion of treatment completion was 73.2%, 70.6% among smear-positive pulmonary cases, and 74.0% among culture-positive pulmonary cases. Among these cases, 19.8% had a potentially unfavorable outcome, of which 44% were lost to follow-up, 25% were transferred patients, 13% were patients still undergoing treatment at 12 months, 9% were tuberculosis-related deaths, and 9% were cases that had discontinued and not resumed treatment. The steady decrease in the number of cases with an unknown treatment outcome and the decrease in the number of departments that did not provide information on treatment outcomes indicate improved reporting and possibly better case follow-up. The percentage of patients who completed treatment, which increased over the study period, suggests improved care for these patients. Although these results are encouraging, they are insufficient and fall short of the World Health Organization’s target of at least a 90% cure rate for smear-positive pulmonary cases. They should encourage these various stakeholders to continue and strengthen this surveillance.
Author(s): Guthmann JP, Antoine D, Levy Bruhl D
Publishing year: 2018
Pages: 95-104
Weekly Epidemiological Bulletin, 2018, n° 6-7, p. 95-104
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