Progress and problems in achieving the United States national target for completion of antituberculosis treatment

SETTING: The target for antituberculosis treatment in the United States is for 90% of patients to complete therapy within 12 months. OBJECTIVE: To assess progress in achieving the US national target for tuber culosis treatment. DESIGN: A comparison of treatment outcome in two cohorts of patients with d rug-susceptible tuberculosis in California--those reported in 1993-1994 (84 88 patients) and 1995-1996 (7823 patients). Risk factors for delay in treat ment completion (more than 12 months) were assessed. RESULTS: The percentage of cases completing treatment within 12 months incr eased in the 1995-1996 cohort (to 68.2%), primarily due to concomitant redu ctions in delays in treatment completion (to 11.1%) and defaulting (to 2.4% ). Disparities in timely treatment completion narrowed over time and in nea tly all subpopulations, especially in groups with lowest treatment completi on in the 1993-1994 cohort. Remaining risk factors for delay in treatment c ompletion included AIDS and older ages. A substantial percentage of patient s died or moved before treatment completion. CONCLUSIONS: Despite recent improvements, completion of antituberculosis tr eatment in California has not reached the national target. Reaching this ta rget will require further reductions in delays in treatment completion and deaths during treatment, and ensuring that patients who move eventually com plete treatment.