Team-based, hybrid, or standard of care? Organizational models of tuberculosis care on tuberculosis outcomes in eleven Italian hospital

Abstract

Objectives: Tuberculosis (TB) continues to pose challenges in high-income countries, among migrant and socioeconomically vulnerable populations. Treatment discontinuity and loss to follow up (LTFU) remain critical barriers to TB control. This study evaluated the impact of three organizational models of TB care on clinical and programmatic outcomes in Italy.

Methods: We conducted a multicentre study including all TB patients diagnosed between 2021 and 2024 in 11 hospitals in five regions. Centres were categorized into three care models: (i) TB team (structured care with trained staff, dedicated outpatient clinics, and proactive follow-up); (ii) hybrid centre (HC); and (iii) standard-of-care (SOC). Primary outcomes included hospital length of stay, incidence and severity of adverse events, treatment completion, and LTFU. Mixed-effect regression models adjusted for confounders.

Results: Of 717 pansusceptible and monoresistant TB patients, 375 (52.3%) were treated in TB team centres, 175 (24.4%) in HC, and 167 (23.3%) in SOC centres. Treatment completion was higher in TB team (327/375, 87.2%) vs. HC (116/162, 71.6%) and SOC centres (89/158, 56.3%) (p < 0.0001), whereas LTFU was lowest in TB team (35/375, 9.3%) vs. HC (44/162 27.2%) and SOC (63/158, 39.9%) (p < 0.0001). Hospital stay was shorter in the TB team (median 26 days, interquartile range (IQR), 15-55) and HC (35 days, IQR, 22-62) compared with SOC (50 days, IQR, 22-82) (p < 0.0001). The occurrence of adverse events was similar (p 0.54), with lower severity in the TB team and HC. Adjusted analyses confirmed lower risk of incomplete treatment (OR, 0.10; 95% CI, 0.03-0.30), LTFU (OR, 0.09; 95% CI, 0.04-0.23), and severe adverse events (OR, 0.40; 95% CI, 0.17-0.95) in the TB team vs. SOC.

Discussion: The TB-dedicated care model was associated with improved outcomes, fewer severe adverse events, higher treatment completion rates, and lower LTFU. Although hybrid models conferred intermediate benefit, implementation of TB care ensured consistent gains. These findings support scaling up TB team-based models to strengthen TB control and align with elimination targets.

Keywords: Health system efficiency; Hospital stay; Loss to follow up; Migrant health; Public health interventions; TB Italy; TB care model; TB-dedicated team; Treatment adherence; Tuberculosis.