1. Predictors of Failure in Timely TB Treatment Completion, United States Carla Winston,PhD TB PEN Focal Point Open Forum June 5, 2013 1

2. Measuring Timely COT 2015 National Goal for COT: 93% National Tuberculosis Indicators Project Reporting jurisdictions submit data to the National TB Surveillance System through the Report of Verified Case of Tuberculosis Indicator: Percent of patients with newly diagnosed TB, for whom therapy for 12 months or less is indicated, who completed treatment within 12 months (366 days). Cohort: All TB patients, for whom 12 months of treatment or less is recommended, alive at diagnosis, initiated treatment with one or more drugs, and counted in the cohort period of interest. Excludes: Patients with any rifampin-resistant TB or meningeal TB, and children aged 14 or younger with disseminated TB. Disseminated TB is defined as miliary site of disease, evidence of miliary TB on chest radiograph, or a positive blood culture. Patients who died are excluded. For cohort 2009 and later, patients who moved out of the U.S during treatment are also excluded. 2

3. COT Trend Treatment completion has increased substantially since 1993, and somewhat plateaued early 2000s 93% of persons diagnosed with TB in 2006 did complete treatment at some point. However, only 84% of those who were candidates for a 6–9 month regimen completed it in 12 months. Proportion has remained at approximately 83% since 2003. How can we break-through the plateau? 3

4. Predictors of Non-Completion Major risk factors for non-completion include: Incarceration at diagnosis Homelessness Combined extra-pulmonary and pulmonary disease HIV infection Positive culture 4

5. Why? Notification or discharge hand-off Moving Loss-to follow-up Challenging treatment regimens Adherence concerns Treatment interruptions Health care access Patient preferences 5

6. For Discussion What are some of your best practices for monitoring and improving timely completion? How does your team implement the Interjurisdictional TB Notification and Follow-Up Protocol? How do you work with private, federal, or hospital providers to manage treatment? 6