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2019 State and City TB Report
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, 2017
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 2017.
For these patients, 20 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; 14 states and 2 cities were short of the 2025 target but met or exceeded the national average (89.8%) (Figure 9).
Additionally, in 2017 there were 7 states and 5 cities that reported more than 7 TB patients, ’15 years of age who experienced homelessness in the year prior to diagnosis; 7 of these 12 jurisdictions exceeded the national average of 80.7% completion of therapy among homeless TB patients (Table 1).
There were 8 states and 2 cities in 2017 that reported more than 4 TB patients, 15 years of age or older who were incarcerated at TB diagnosis; 6 of these 10 jurisdictions exceeded the national average of 73.1% completion of therapy among incarcerated TB patients (Table 2 ).
| States* with 1 to 3 TB patients age >15 experiencing homelessness | Percentage of patients age >15 experiencing homelessness who completed treatment within 12 months^ | Percentage of all patients who completed treatment within 12 months† |
|---|---|---|
| Connecticut | 100.0 | 98.0 |
| New Hampshire | 100.0 | 88.2 |
| Pennsylvania | 100.0 | 86.0 |
| Wisconsin | 100.0 | 90.0 |
| Illinois | 100.0 | 91.6 |
| Michigan | 100.0 | 96.0 |
| Kansas | 100.0 | 100.0 |
| Maryland | 100.0 | 82.6 |
| Nevada | 100.0 | 98.5 |
| New Jersey | 100.0 | 92.9 |
| Louisiana | 66.7 | 82.4 |
| Philadelphia | 66.7 | 60.3 |
| Alaska | 50.0 | 91.5 |
| Missouri | 50.0 | 73.6 |
| States* with 4 to 7 TB patients age >15 experiencing homelessness | Percentage of patients age >15 experiencing homelessness who completed treatment within 12 months^ | Percentage of all patients who completed treatment within 12 months† |
|---|---|---|
| Arkansas | 100.0 | 78.9 |
| Colorado | 100.0 | 91.2 |
| Indiana | 100.0 | 96.4 |
| Oregon | 100.0 | 90.2 |
| Ohio | 100.0 | 82.3 |
| Virginia | 100.0 | 97.2 |
| Minnesota | 100.0 | 95.7 |
| Mississippi | 100.0 | 86.4 |
| Washington | 100.0 | 93.4 |
| North Carolina | 85.7 | 93.6 |
| Alabama | 80.0 | 87.9 |
| New York | 80.0 | 92.6 |
| Hawaii | 75.0 | 96.9 |
| San Francisco | 75.0 | 88.5 |
| District of Columbia | 42.9 | 76.7 |
| South Carolina | 40.0 | 92.0 |
| States* with 8 or more TB patients age >15 experiencing homelessness | Percentage of patients age >15 experiencing homelessness who completed treatment within 12 months^ | Percentage of all patients who completed treatment within 12 months† |
|---|---|---|
| Massachusetts | 100.0 | 94.6 |
| Chicago | 100.0 | 90.6 |
| Houston | 92.3 | 85.8 |
| Tennessee | 91.7 | 95.2 |
| Arizona | 84.6 | 92.5 |
| Florida | 82.1 | 95.2 |
| New York City | 81.8 | 92.9 |
| California | 77.5 | 89.3 |
| Los Angeles | 74.1 | 92.1 |
| San Diego | 64.7 | 89.6 |
| Georgia | 61.5 | 86.3 |
| Texas | 60.0 | 82.0 |
| 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, 2017
| 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† |
|---|---|---|
| Alaska | 100.0 | 91.5 |
| Connecticut | 100.0 | 98.0 |
| District of Columbia | 100.0 | 76.7 |
| Indiana | 100.0 | 96.4 |
| New Jersey | 100.0 | 92.9 |
| New York | 100.0 | 92.6 |
| Oklahoma | 100.0 | 95.8 |
| West Virginia | 100.0 | 84.6 |
| Arkansas | 100.0 | 78.9 |
| Delaware | 100.0 | 100.0 |
| Mississippi | 100.0 | 86.4 |
| New Mexico | 100.0 | 96.0 |
| Minnesota | 50.0 | 95.7 |
| South Carolina | 50.0 | 92.0 |
| Virginia | 50.0 | 97.2 |
| Illinois | 0.0 | 91.6 |
| Philadelphia | 0.0 | 60.3 |
| States with 3 to 4 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† |
|---|---|---|
| Los Angeles | 100.0 | 92.1 |
| Massachusetts | 100.0 | 94.6 |
| North Carolina | 100.0 | 93.6 |
| Alabama | 100.0 | 87.9 |
| New York City | 100.0 | 92.9 |
| Colorado | 66.7 | 91.2 |
| Louisiana | 66.7 | 82.4 |
| Georgia | 60.0 | 89.3 |
| States with 5 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† |
|---|---|---|
| Tennessee | 100.0 | 95.2 |
| Washington | 100.0 | 93.4 |
| Arizona | 94.4 | 92.5 |
| Houston | 85.7 | 85.8 |
| Florida | 83.3 | 95.2 |
| San Diego | 80.0 | 89.6 |
| Georgia | 71.4 | 86.3 |
| Missouri | 66.7 | 73.6 |
| California | 63.6 | 89.3 |
| Texas | 46.8 | 82.0 |
Figure 9. Percentage of Newly Diagnosed TB Cases Completing Treatment ≤12 Months, United States, 2017
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 2017.
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 2017. Due to the small denominator, data should be interpreted with caution.
Data source: National Tuberculosis Surveillance System as of June 10, 2020
Table 1. Treatment Completion within 12 Months among Newly Diagnosed TB Patients Age ≥15 who Experienced Homelessness within the Year Prior to Diagnosis, United States, 2017
*States/cities are grouped into thirds based on numbers of homeless TB cases reported in 2017.
^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, DE, IA, ID, KY, ME, MT, NE, ND, NM, OK, RI, SD, UT, VT, 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 10, 2020
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, 2017
*States/cities are grouped into thirds based on numbers of incarcerated TB cases reported in 2017.
^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, HI, IA, ID, KS, KY, MD, ME, MI, MT, ND, NE, NH, NV, OH, OR, PA, RI, San Francisco, SD, UT, VT, WI, 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 10, 2020