Outcome of tuberculosis treatment in Hamburg: a survey, 1997-2001

SETTING: Federal State of Hamburg, Germany, 1997-2001. OBJECTIVE: To determine risk factors affecting the treatment outcome for tuberculosis according to the V WHO/IUATLD classification. DESIGN: Prospective, evaluation among patients with culture-confirmed pulmonary disease due to Mycobacterium tuberculosis during the period 1997-1999. RESULTS: Five hundred and eighteen (467 new and 51 re-treatment) cases started a course of treatment (average duration 36.1 +/- 15.5 weeks), resulting in cure for 416 (80.3%) and treatment completed for three (0.6%) patients; 449 patients (86.7%) initially received a three-drug regimen. Treatment interruption occurred in 54 (10.4%), and failure in 12 (2.3%) cases; 32 (6.2%) patients died (irrespective of cause). Alcohol dependence appeared to be the strongest risk factor for persistence of disease, followed by homelessness and unemployment. The risk of treatment interruption was six times higher among alcoholics (OR = 6.0), five times higher among drug abusers (OR = 5.2) and three times higher among the homeless (OR =3.0) than in other patients. CONCLUSION: Although the current treatment management in Hamburg is considered to be effective, a further improvement in the proportion of patients who complete treatment can be achieved by increased public health surveillance of subpopulations with the above-mentioned risk factors.