Exploring the determinants of treatment success for tuberculosis cases in Europe

SETTING: Pooled tuberculosis (TB) notifications from 13 European countries.

OBJECTIVE: To analyse the determinants of TB treatment success in different countries using individual data.

DESIGN: We asked 18 European countries with both outcome data and individual TB records to code outcomes for cases notified in 2000 and/or 2001. Cases completing treatment regardless of bacteriological proof of cure were considered successful.

RESULTS: Ten European Union countries and Iceland, Norway and Romania participated (72% response). Among 24660 TB cases (Romania excluded), ‘success’ was reported in 69% (country range 60–88%), 9% (0–11%) died, 1% (0–5%) failed, 4% defaulted or transferred (2–15%) and 12% (0–23%) were ‘unknown’. On logistic regression among cases with drug susceptibility results (n = 10303), ‘success’ was associated with younger age (>74 years: reference; 55–74 years: OR = 2.0, 95%CI 1.8–2.4; 35–54 years: 3.0, 95%CI 2.6–3.5; 15–34 years: 3.7, 95%CI 3.2–4.4; <15 years: 4.4, 95%CI 2.9–6.7), female sex (1.4, 95%CI 1.3–1.6), and no polyresistance (9.2, 95%CI 6.8–12.4). The Netherlands (1.6, 95%CI 1.3–2.0) and Slovakia (1.8, 95%CI 1.4–2.2) had higher success than Estonia (reference: lowest percentage success), while Austria was lower (0.64, 95%CI 0.52–0.78).

CONCLUSION: Preventing drug resistance, increasing adherence and improving care in the elderly should be priorities. Inter-country variations in treatment success suggest differences in the completeness of monitoring data and in the efficacy of national control programmes.