Outcome of pulmonary tuberculosis treatment in the tertiary care setting--Toronto 1992/93. Tuberculosis Treatment Completion Study Group.

BACKGROUND Completion of treatment of active cases of tuberculosis (TB) is the most important priority of TB control programs. This study was carried out to assess treatment completion for active cases of pulmonary TB in Toronto. METHODS Consecutive cases of culture-proven pulmonary TB were obtained from the microbiology laboratories of 5 university-affiliated tertiary care centres in Toronto in 1992/93. A standard data-collection tool was used to abstract information from inpatient and outpatient charts. For patients who were transferred to other treatment centres or lost to follow-up, the local health unit was contacted for information about treatment completion. If incomplete information was obtained from these sources, data from the provincial Reportable Disease Information System were also reviewed. The main outcome analysed was treatment outcome, with cases classified as completed (record of treatment completion noted), transferred (patient transferred to another centre but no treatment results available), defaulted (record of defaulting in patient chart but no record of treatment completion elsewhere, or patient still receiving treatment more than 15 months after diagnosis) or dead (patient died before treatment completion). RESULTS Of the 145 patients 84 (58%) completed treatment, 25 (17%) died, 22 (15%) defaulted and 14 (10%) were transferred. The corresponding values for the 22 patients with HIV coinfection were 6 (27%), 5 (23%), 8 (36%) and 3 (14%). Independent predictors of failure to complete treatment were injection drug use (adjusted odds ratio [OR] 5.7, 95% confidence interval [CI] 1.5 to 22.0), HIV infection (adjusted OR 4.6, 95% CI 1.4 to 14.7) and adverse drug reaction (adjusted OR 2.9, 95% CI 1.1 to 7.9). Independent predictors of death included age more than 50 years (adjusted OR 16.7, 95% CI 2.6 to 105.1), HIV infection (adjusted OR 16.1, 95% CI 3.9 to 66.4), immunosuppressive therapy (adjusted OR 8.0, 95% CI 1.9 to 34.4) and infection with a multidrug-resistant organism (adjusted OR 30.7, 95% CI 1.5 to 623.0). INTERPRETATION Treatment completion rates in tertiary care hospitals in Toronto in 1992/93 were below the rate recommended by the World Health Organization. Careful surveillance of treatment completion is necessary for the management of TB in metropolitan centres in Canada.