Treatment of Active Tuberculosis in Chicago, 2008-2011: The Role of Public Health Departments

OBJECTIVE Evaluate differences in TB outcomes among different provider types in Chicago, IL. METHODS We retrospectively reviewed all TB cases reported to the Chicago Department of Public Health (CDPH) from 2008 through 2011. Provider type was stratified into three groups: public, public-private, and private providers. Multivariate regression was used to evaluate treatment duration and time to sputum culture conversion. A Cox proportional hazard model was used to assess treatment completion. RESULTS Of 703 cases, 203 (28.9%), 314 (44.7%), and 186 (26.5%) were treated by public, public-private and private providers, respectively. Adjusted regression showed private provider patients had a 48-day (95% CI 22.0-74.3) increase in treatment duration and a 30-day (95% C.I. 9.5-51.1) increase in time to sputum culture conversion. Cox model showed increased risk of remaining on treatment was associated with extra-pulmonary TB (aHR 0.78, 95% C.I. 0.62-0.98), being foreign-born (aHR 0.74, 95% C.I. 0.58-0.95), and any drug resistance (aHR 0.59, 95% C.I. 0.46-0.76). There were no differences in outcomes between public and public-private providers. CONCLUSION Patients treated solely in the private sector had prolonged time to sputum culture conversion and treatment duration which lead to increased cost for treatment, prolonged infectiousness, potential for transmission, and the possibility for increased medication side effects.