2018 State and City TB Report

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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.

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

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

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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

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