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2020 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 correctional facilities.
Figure 7. Percentage of Newly Diagnosed TB Cases Completing Treatment ≤12 Months, United States, 2018
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
- Promoting the shortest appropriate treatment regimen for each patient
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 2018.
For these patients, 13 states 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 5 cities were short of the 2025 target but met or exceeded the national average (89.1%) (Figure 7).
Additionally, in 2018 there were 10 states and 6 cities that reported more than 6 TB patients ages 15 years or older who experienced homelessness in the year prior to diagnosis; 7 of these 16 jurisdictions exceeded the national average of 80.6% completion of therapy among TB patients who experienced homelessness (Table 1).
There were 5 states and 4 cities in 2018 that reported more than 4 TB patients ages 15 years or older who were residents of correctional facilities at TB diagnosis; 4 of these 9 jurisdictions exceeded the national average of 72.6% completion of therapy among TB patients residing at correctional facilities (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† |
|---|---|---|
| Delaware | 100.0 | 83.3 |
| Maryland | 100.0 | 77.4 |
| Missouri | 100.0 | 74.2 |
| New Hampshire | 100.0 | 100.0 |
| North Dakota | 100.0 | 81.8 |
| Philadelphia | 100.0 | 72.3 |
| Alaska | 100.0 | 93.0 |
| Connecticut | 100.0 | 100.0 |
| Pennsylvania | 100.0 | 91.7 |
| Utah | 100.0 | 100.0 |
| Wisconsin | 100.0 | 85.7 |
| Colorado | 100.0 | 96.6 |
| Hawaii | 100.0 | 94.1 |
| Massachusetts | 100.0 | 81.7 |
| Michigan | 100.0 | 95.3 |
| Oregon | 100.0 | 95.8 |
| Oklahoma | 66.7 | 94.8 |
| Baltimore | 50.0 | 77.8 |
| Kansas | 0.0 | 73.9 |
| Kentucky | 0.0 | 85.1 |
| Virginia | 0.0 | 94.0 |
| States* with 4 to 6 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† |
|---|---|---|
| Indiana | 100.0 | 95.8 |
| New York | 100.0 | 95.7 |
| Ohio | 100.0 | 85.9 |
| South Carolina | 100.0 | 93.4 |
| Illinois | 100.0 | 90.1 |
| Nevada | 100.0 | 100.0 |
| Washington | 100.0 | 94.1 |
| Louisiana | 83.3 | 75.8 |
| Alabama | 80.0 | 85.2 |
| New Mexico | 80.0 | 91.2 |
| Maine | 75.0 | 84.6 |
| Minnesota | 75.0 | 92.1 |
| States* with 7 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† |
|---|---|---|
| Florida | 100.0 | 97.2 |
| Arizona | 90.0 | 85.1 |
| Tennessee | 88.9 | 92.6 |
| New Jersey | 87.5 | 91.7 |
| Mississippi | 85.7 | 93.8 |
| Texas | 82.8 | 84.1 |
| North Carolina | 81.8 | 86.5 |
| California | 80.0 | 88.0 |
| San Francisco | 75.0 | 90.0 |
| San Diego | 75.0 | 85.3 |
| Georgia | 72.7 | 92.8 |
| Houston | 57.1 | 90.4 |
| New York City | 57.1 | 93.1 |
| Los Angeles | 55.6 | 89.6 |
| Arkansas | 42.9 | 76.8 |
| Chicago | 42.9 | 88.2 |
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, 2018
| 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† |
|---|---|---|
| Chicago | 100.0 | 88.2 |
| Connecticut | 100.0 | 100.0 |
| Illinois | 100.0 | 90.1 |
| Louisiana | 100.0 | 75.8 |
| Minnesota | 100.0 | 92.1 |
| New York | 100.0 | 95.7 |
| Pennsylvania | 100.0 | 91.7 |
| Tennessee | 100.0 | 92.6 |
| Alabama | 50.0 | 85.2 |
| Colorado | 50.0 | 96.6 |
| Michigan | 50.0 | 95.3 |
| Missouri | 50.0 | 74.2 |
| New Mexico | 50.0 | 91.2 |
| San Francisco | 50.0 | 90.0 |
| 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† |
|---|---|---|
| Indiana | 100.0 | 95.8 |
| New Jersey | 100.0 | 91.7 |
| Ohio | 100.0 | 85.9 |
| Washington | 80.0 | 94.1 |
| Mississippi | 75.0 | 93.8 |
| North Carolina | 75.0 | 86.5 |
| Massachusetts | 60.0 | 81.7 |
| 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† |
|---|---|---|
| San Diego | 100.0 | 85.3 |
| Houston | 88.9 | 90.4 |
| Arizona | 88.9 | 85.1 |
| Florida | 87.5 | 97.2 |
| Los Angeles | 71.4 | 89.6 |
| California | 70.6 | 88.0 |
| New York City | 57.1 | 93.1 |
| Georgia | 55.6 | 92.8 |
| Texas | 55.6 | 84.1 |
Figure 7. Percentage of Newly Diagnosed TB Cases Completing Treatment ≤12 Months, United States, 2018
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 2018. Due to the small denominator, data should be interpreted with caution.
Data source: National Tuberculosis Surveillance System as of June 14, 2021
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, 2018
*States/cities are grouped into thirds based on numbers of TB cases among persons experiencing homelessness reported in 2018.
^Among those age >15 years who were eligible to complete treatment within 12 months.
†Among all patients of any age who were eligible to complete treatment within 12 months (including those who experienced homelessness in the past year).
Note: DC, IA, ID, MT, NV, RI, SD, 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 14, 2021
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, 2018
*States/cities are grouped into thirds based on numbers of incarcerated TB cases reported in 2018.
^Among those age ≥15 years who were eligible to complete treatment within 12 months.
†Among all patients of any age who were eligible to complete treatment within 12 months (including those who were incarcerated at diagnosis).
Note: AK, AR, Baltimore, DC, DE, HI, IA, ID, KS, KY, MD, ME, MT, ND, NE, NH, NV, OK, OR, Philadelphia, RI, SC, SD, UT, VA, VT, WI, WV, WY did not report TB cases among incarcerated persons age ≥15 years who were eligible to complete treatment.
Data source: National Tuberculosis Surveillance System as of June 14, 2021