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 24 660 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 = 10 303), '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.