Evaluation and determinants of outcome of tuberculosis treatment

Abstract

The most important determinant of the outcome of treatment of tuberculosis (TB) patients is the access that they have to reliable diagnosis and treatment services organized within a national tuberculosis programme (NTP) as part of DOTS, the name of the WHO-recommended TB control strategy. Accurate evaluation of treatment outcomes requires inclusion of all patients diagnosed, including those not registered; part of routine NTP management should therefore involve regular cross-checks between laboratory diagnostic registers and NTP treatment registers. Finally, control services should take into consideration the type of TB, the presence of concomitant infection with human immunodeficiency virus (HIV), and patient characteristics.

PIP: The key determinant of the outcome of tuberculosis treatment is access to reliable diagnosis and treatment services organized within a national tuberculosis program that employs the directly observed treatment, short-course (DOTS) control strategy. The analysis (presented in another paper in this issue) of the determinants of treatment outcome of tuberculosis patients in Karonga District, Malawi, suggests three conclusions. Firstly, well-organized tuberculosis control strategies are necessary to ensure that patients are registered and therefore enhance their chances of survival. Secondly, failure to include patients who are diagnosed but unregistered results in an overly optimistic evaluation of program outcomes. Thirdly, control programs must take into consideration the determinants of outcome relating to the type of tuberculosis, the presence of concomitant infection with HIV, and patient characteristics. The increased risk of mortality in HIV-infected tuberculosis patients, both during and after treatment, poses considerable challenges and raises case fatality rates.