Gül ÖNGEN, Aylin BABALIK, Şule KIZILTAŞ, Serap GENCE, Zeki KILIÇASLAN

A retrospective case-control study, factors affecting treatment outcomes for Pulmonary Tuberculosis in İstanbul, Turkey

Background: Tuberculosis is a public health problem and its transmission is a threat to the community. Aims: The aim of this study was to determine the factors influencing the treatment outcomes and the effectiveness of the National Tuberculosis Program (NTP) in relation to the application of the directly observed treatment, short-course (DOTS) program in various sites in Istanbul, Turkey. Study Design: Case-Control Study Methods: A case-control study was used, where cases and controls were randomly selected from the Turkish Tuberculosis National Database, which includes complete data on treatment outcomes for patients recorded in the database from January 1, 2006 to December 31, 2009 and had one year follow-up. Results: The case group was composed of 464 patients with adverse outcome, while the control group was composed of 441 patients who had been cured of disease. Factors associated with adverse treatment outcome were >65 years of age (OR: 3.39 (1.99-5.76)) ; male gender (OR:2.11 (1.49-2.99)); born outside Turkey (OR: 5.48 (2.13-14.04)); co-morbidity (OR: 1.85 (1.29-2.65)); bilateral radiologic lesions (OR: 2.07 (1.41-3.00); previous treatment his- tory (OR: 3.99 (2.78-5.74)); 3rd month positive microscopy (OR: 4.96 (3.04-8.09)) and any H&R +/- others multidrug resistant (MDR) resistance (OR: 22.64 (6.92-74.08)). There was no association between the adverse treatment outcome and the application site of direct observation treatment, short course (DOTS) delivery and the supervisors. Conclusion: Our findings indicate similar quality in DOTS application and supervision among patients with or without adverse treatment outcomes. How- ever, patients with certain characteristics should be carefully monitored and aggressively treated.

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1. World Health Organization. Treatment of Tuberculosis: Guide- lines. 4th ed. WHO/HTM/TB/2009.420. Geneva, Switzerland: WHO, 2009.
2. World Health Organization. Forty-fourth World Health Assembly, resolutions and decisions. Resolution WHA 44.8. WHA44/1991/ REC/1. Geneva, Switzerland: WHO, 1991.
3. Kumaresan J, Heitkamp P, Smith I, Billo N. Global Partnership to Stop TB: a model of an effective public health partnership. Int J Tuberc Lung Dis 2004;8:120-9.
4. World Health Organization. Global Tuberculosis Control: The burden of disease caused by TB. WHO/HTM/TB/2011.16. Geneva, Switzerland: WHO, 2011.
5. Dye C Garnett GP, Sleeman K, Williams BG. Prospects for world- wide tuberculosis control under the WHO DOTS strategy. Lancet 1998;352:1886-91. [CrossRef]
6. Bozkurt H, Türkkanı MH, Musaonbaşıoğlu S, Yıldırım A, Baykal F. Fight against tuberculosis 2011 report of Turkey. Ankara, Ministry of Health of Turkey Republic; 2011.
7. Akdağ R, Tosun N, Erkoç Y, Bozgan T, Bozkurt H. Diagnosis and treatment of tuberculosis. Ankara, Ministry of Health of Turkey Republic; 2011.q
8. Lefebvre N, Falzon D. Risk factors for death among tuberculosis cases: analysis of European surveillance data. Eur Respir J 2008;31:1256-60. [CrossRef]
9. Nájera-Ortiz JC, Sánchez-Pérez HJ, Ochoa-Díaz H, Arana-Cede- ño M, Lezama MS, Mateo MM. Demographic, health services and socio-economic factors associated with pulmonary tuberculosis mortality in Los Altos Region of Chiapas, Mexico. Int J Epidemiol 2008;37:786-95.
10. Vasankari T, Holmström P, Ollgren J, Liippo K, Ruutu P. Treatment outcome of extra-pulmonary tuberculosis in Finland: a cohort study. BMC Public Health 2010;10:399. [CrossRef]
11. Farah MG, Tverdal A, Steen TW, Heldal E, Brantsaeter AB, Bjune G. Treatment outcome of new culture positive pulmonary tuberculosis in Norway. BMC Public Health 2005;5:14. [CrossRef]
12. Faustini A, Hall AJ, Perucci CA. Tuberculosis treatment outcomes in Europe: a systematic review. Eur Respir J 2005;26:503-10. [CrossRef]
13. Baussano I, Pivetta E, Vizzini L, Abbona F, Bugiani M. Predicting tuberculosis treatment outcome in a low-incidence area. Int J Tuberc Lung Dis 2008;12:1441-8.
14. Talay F, Kumbetli S, Altin S. Factors associated with treatment success for tuberculosis patients: a single center’s experience in Turkey. Jpn J Infect Dis 2008;61:25-30.
15. Vasankari T, Holmström P, Ollgren J, Liippo K, Kokki M, Ruutu P. Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study. BMC Public Health 2007;7:291. [CrossRef]
16. N. Bock. What is the significance of default (treatment interrup- tion) in the treatment of tuberculosis? Toman’s Tuberculosis Case detection, treatment, and monitoring questions and answers Edited by T. Frieden
17. Borgdorff MW, Nagelkerke NJ, Dye C, Nunn P. Gender and tuberculosis: a comparison of prevalence surveys with notification data to explore sex differences in case detection. Int J Tuberc Lung Dis 2000;4:123-32.
18. Kapella BK, Anuwatnonthakate A, Komsakorn S, Moolphate S, Charusuntonsri P, Limsomboon P, et al. Directly observed treatment is associated with reduced default among foreign tuberculosis patients in Thailand. Int J Tuberc Lung Dis 2009;13:232-7.
19. Caylà JA, Rodrigo T, Ruiz-Manzano J, Caminero JA, Vidal R, García JM, et al. Tuberculosis treatment adherence and fatality in Spain. Respir Res 2009;10:121. [CrossRef]
20. Indicators for Program Outcomes. Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs WHO/HTM/TB/2004.344
21. Mak A, Thomas A, Del Granado M, Zaleskis R, Mouzafarova N, Menzies D. Influence of multidrug resistance on tuberculosis treatment outcomes with standardized regimens. Am J Respir Crit Care Med 2008;178:306-12. [CrossRef]
22. COMPEDIUM of indicators for monitoring and evaluating nation- al tuberculosis programs WHO/HTM/TBT 2004.344
23. Garrido Mda S, Penna ML, Perez-Porcuna TM, de Souza AB, Marreiro Lda S, Albuquerque BC, et a. Factors associated with tuberculosis treatment default in an endemic area of the brazilian Amazon: a case control-study. PLoS One 2012;7:e39134. [CrossRef]
24. Horne DJ, Royce SE, Gooze L, Narita M, Hopewell PC, Nahid P, et al. Sputum monitoring during tuberculosis treatment for predicting outcome: systematic review and meta-analysis. Lancet Infect Dis 2010;10:387-94. [CrossRef]
25. Lin HH, Ezzati M, Murray M. Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and meta-analysis. PLoS Med 2007;4:e20. [CrossRef]
26. Volmink J, Garner P. Directly observed therapy for treating tuber- culosis. Cochrane Database Syst Rev 2007;4:CD003343.
27. Suárez PG, Watt CJ, Alarcón E, Portocarrero J, Zavala D, Canales R, et al. The dynamics of tuberculosis in response to 10 years of intensive control effort in Peru. J Infect Dis 2001;184:473-8. [CrossRef]
28. Kilicaslan Z, Oztürk F, Sarimurat N, Cuhadaroglu C, Caglar E, Erem A. Microscopic examination and treatment outcomes of new pulmonary tuberculosis cases in Istanbul dispensaries between 1998 and 2000. Int J Tuberc Lung Dis 2003;7:1059-63.