OUTCOME OF PATIENTS TREATED FOR TUBERCULOSIS IN VAUD COUNTY, SWITZERLAND

SETTING: The outcome of tuberculosis treatment is often not assessed i n low-incidence countries such as Switzerland. In economically develop ed countries, private practitioners do not have the final responsibili ty for ensuring the completion of adequate tuberculosis treatment, and public health officers have little or no legal means of intervening i f they are not specifically requested to do so. Furthermore, the reluc tance of private practitioners to follow official guidelines may be an obstacle to the implementation of a regular surveillance policy. OBJE CTIVE: To assess the results of treatment in patients with culture-pos itive pulmonary tuberculosis and to identify the risk factors for non- adherence to treatment. DESIGN: Retrospective study of all cases notif ied between 1988 and 1992 in Vaud County, and mainly treated by indepe ndent practitioners. RESULTS: Among 133 patients notified with culture -positive pulmonary tuberculosis, complete information about treatment outcome was available for 120. Treatment success (cure or completed a dequate treatment) was observed in 84 patients (70%), 17 died (14%) an d 19 (16%) were considered as defaulters. The default rate was higher among immigrants, alcoholics, intravenous drug users and male patients . Among non-adherent patients, 4/19 (21%) relapsed within 3 years, com pared with 3/84 (4%) among adherent patients. CONCLUSION: The outcome of treatment in this group of patients does not correspond to the expe cted standards: the treatment completion rate was too low, and the def ault rate was too high. Better education of medical staff and health-c are workers, use of directly-observed treatment, and regular surveilla nce of treatment outcome will be necessary to improve the results.