2018 State and City TB Report

Return to Main Menu

Completion of Therapy

Fully treating and, therefore, preventing further spread of M. tuberculosis is key to TB control and elimination. If TB drugs are stopped too soon or not taken correctly, a person may develop symptoms again or drug resistance may develop, enabling the further spread of TB. Each patient is unique.

There are many reasons why a patient might be unable or unwilling to complete TB treatment, such as:

  • No longer experiencing symptoms of TB, not fully understanding the treatment regimen
  • Not being willing or able to manage side effects of their treatment regimen,
  • Cultural beliefs
  • Language barriers
  • Difficulty getting health care
  • Substance use
  • Mental health issues

Completion of therapy among persons who have experienced homelessness or been incarcerated can be particularly challenging due to difficulty locating patients for follow-up care and treatment, but is particularly important because of the risk of transmission at shelters or in the jail or prison systems.

Figure9

Figure 9. Percentage of Newly Diagnosed TB Cases Completing Treatment ≤12 Months, United States, 2016

There are several ways to increase treatment completion. These include:

  • Directly observed therapy (i.e., patients are observed to ingest each dose of anti-TB medications)
  • Use of incentives and enablers (e.g., gift cards for food or bus fare for transportation to get to and from the health department) to get patients to complete treatment

TB treatment is complex and can take several months to complete.  It can take up to 2 years to have full treatment information reported for each TB patient.  As a result, the most recent information available on completion of therapy is from patients in the 50 states and 9 cities who were identified with TB in 2016.

For these patients, 11 states and one city met or exceeded the 2025 national target of 95.0% of TB cases completing a full treatment regimen in 12 months or less; 19 states and 4 cities were short of the 2025 target but met or exceeded the national average (89.2%) (Figure 9image icon, Footnotes).

Additionally, in 2016 there were 8 states and 5 cities that reported more than 7 TB patients, 15 years of age or older who were homeless in the year prior to diagnosis; 8 of these 13 jurisdictions exceeded the national average of 84.9% completion of therapy among homeless TB patients (Table 1, Footnotes).

There were 6 states and 2 cities in 2016 that reported more than 5 TB patients, 15 years of age or older who were incarcerated at TB diagnosis; 6 of these 8 jurisdictions exceeded the national average of 76.7% completion of therapy among incarcerated TB patients (Table 2 , Footnotes).

Table 1. Treatment Completion within 12 Months or Less among Newly Diagnosed TB Patients Age ≥15 who were Homeless within the Year Prior to Diagnosis, United States, 2016

States with 1 to 3 TB patients age ≥ 15 who were homeless
States with 1 to 3 TB patients age ≥ 15 who were homeless Percentage of homeless patients age ≥ 15 who completed
treatment within 12 months^
Percentage of all patients who completed
treatment within 12 months†
Arkansas 100 78.6
Baltimore 100 100.0
Colorado 100 89.1
Hawaii 100 99.0
Maine 100 95.2
Maryland 100 92.6
Missouri 100 78.4
New Mexico 100 89.7
New York 100 95.7
Utah 100 94.4
Vermont 100 100.0
Virginia 100 92.4
Wisconsin 100 85.3
Oklahoma 50 94.9
District of Columbia 0 94.7
Philadephia 0 68.3
South Dakota 0 88.9
States with 4 to 7 TB patients age ≥ 15 who were homeless
States with 4 to 7 TB patients age ≥ 15 who were homeless Percentage of homeless patients age ≥ 15 who completed
treatment within 12 months^
Percentage of all patients who completed
treatment within 12 months†
Chicago 100 91.1
Indiana 100 92.3
Kansas 100 91.9
Kentucky 100 96.1
Michigan 100 94.8
Minnesota 100 94.2
Nevada 100 95.3
Alabama 83.3 86.6
Arizona 83.3 87.4
Ohio 80.0 76.9
Pennsylvania 75.0 84.1
South Carolina 75.0 94.0
Washington 75.0 92.1
Illinois 71.4 92.5
Massachusetts 71.4 88.5
Mississippi 71.4 89.4
Louisiana 66.7 75.9
Oregon 66.7 79.7
States with 8 or more TB patients age ≥ 15 who were homeless
States with 8 or more TB patients age ≥ 15 who were homeless Percentage of incarcerated patients age ≥ 15 who completed
treatment within 12 months^
Percentage of all patients who completed
treatment within 12 months†
Alaska 100.0 88.9
New Jersey 100.0 93.8
Georgia 95.8 89.3
Florida 95.0 93.1
Los Angeles 94.9 90.8
San Diego 94.1 87.6
San Francisco 87.5 87.5
Tennessee 87.5 95.3
New York City 81.0 93.3
California 80.0 87.2
North Carolina 77.8 91.0
Houston 73.7 89.1
Texas 68.0 84.0

Table 2. Treatment Completion within 12 Months or Less among Newly Diagnosed TB Patients Age ≥15 who were Incarcerated at the Time of Diagnosis, United States, 2016

States with 1 to 2 TB patients age > 15 who were incarcerated
States with 1 to 2 TB patients age ≥ 15 who were incarcerated Percentage of incarcerated patients age ≥ 15 who completed
treatment within 12 months^
Percentage of all patients who completed
treatment within 12 months†
Alabama 100.0 86.6
Alaska 100.0 88.9
Arkansas 100.0 78.6
Illinois 100.0 92.5
Indiana 100.0 92.3
Louisiana 100.0 75.9
Maryland 100.0 92.6
Mississippi 100.0 89.4
New Jersey 100.0 93.8
New Mexico 100.0 89.7
New York 100.0 95.7
North Dakota 100.0 90.5
Pennsylvania 100.0 84.1
Utah 100.0 94.4
Virginia 100.0 92.4
Massachusetts 0.0 88.5
Philadelphia 0.0 68.3
States with 3 to 5 TB patients age > 15 who were incarcerated
States with 3 to 5 TB patients age ≥ 15 who were incarcerated Percentage of incarcerated patients age ≥ 15 who completed
treatment within 12 months^
Percentage of all patients who completed
treatment within 12 months†
Colorado 100.0 89.1
Kentucky 100.0 96.1
Missouri 100.0 78.4
Tennessee 100.0 95.3
Washington 80.0 92.1
North Carolina 66.7 91.0
Oregon 66.7 79.7
Georgia 60.0 89.3
States with 6 or more TB patients age ≥ 15 who were incarcerated
States with 6 or more TB patients age ≥ 15 who were incarcerated Percentage of homeless patients age ≥ 15 who completed
treatment within 12 months^
Percentage of all patients who completed
treatment within 12 months†
Florida 100.0 93.1
San Diego 92.9 87.6
Los Angeles 85.7 90.8
New York City 85.7 93.3
Houston 80.8 89.1
Arizona 77.8 87.4
Texas 66.7 84.0
California 61.9 87.2
Footnotes

Figure 9.  Percentage of Newly Diagnosed TB Cases Completing Treatment ≤12 Months, United States, 2016

The fraction in each parenthesis reports the number of TB patients who completed treatment within 12 months out of the total number of patients who were eligible to complete treatment within 12 months.
States/cities are grouped into thirds based on numbers of TB cases reported in 2016.
Baltimore, DC, DE, IA, ID, KS, ME, MT, ND, NE, NH, NM, RI, SD, UT, VT, WV, WI and WY reported 50 or fewer total TB cases in 2016. Due to the small denominator, data should be interpreted with caution.

Data source: National Tuberculosis Surveillance System as of June 6, 2019

Table 1. Treatment Completion within 12 Months or Less among Newly Diagnosed TB Patients Age ≥15 who were Homeless within the Year Prior to Diagnosis, United States, 2016

*States/cities are grouped into thirds based on numbers of homeless TB cases reported in 2016.
^Among those age >15 who were eligible to complete treatment within 12 months
Among all patients of any age who were eligible to complete treatment within 12 months
Note: CT, DE, IA, ID, MT, NH, NE, ND, RI, WV, WY did not report TB cases among persons age >15 experiencing homelessness who were eligible to complete treatment.

Data source: National Tuberculosis Surveillance System as of June 6, 2019

Table 2. Treatment Completion within 12 Months or Less among Newly Diagnosed TB Patients Age ≥15 who were Incarcerated at the Time of Diagnosis, United States, 2016

*States/cities are grouped into thirds based on numbers of incarcerated TB cases reported in 2016.
^Among those age >15 who were eligible to complete treatment within 12 months
Among all patients of any age who were eligible to complete treatment within 12 months
Note: Baltimore, Chicago, CT, DC, DE, HI, IA, ID, KS, ME, MI, MN, MT, NE, NH, NV, OH, OK, RI, San Francisco, SC, SD, VT, WI, WV, WY did not report TB cases among incarcerated persons age >15 who were eligible to complete treatment.

Data source: National Tuberculosis Surveillance System as of June 6, 2019

Page last reviewed: February 28, 2020