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378-PC11 A comparison of the tuberculosis control programs in San Francisco, USA and Zürich, Switzerland
Abstracts
treatment outcome, and bacteriological resistance of M. tuberculosis isolates.
Results: Of the 847 cases, 620 were bacteriologically +ve (548 of 690 pulmonary TB cases and 72 of 157 nonpulmonary cases), with 267 of 548 bacteriologically +ve pulmonary TB (PTB) cases being sputum smear +ve (a further 54 being smear +ve from bronchial washing without having had microscopy of sputum performed prior to surveillance during treatment). Of the 548 cases of bacteriologically proven PTB, 436 completed treatment (422 adequate treatment, 14 irregular treatment) with cure, and there was only one treatment failure. Of the remaining 111, 38 emigrated from Qld and were properly referred to clinicians outside of Qld, while three were lost to follow up. The remaining 70 were either post mortem notifications (11) or deceased before commencing (l) or during TB treatment (58). Of the 58 dying during TB treatment, 16 died due to TB and 42 with TB. Conclusion: The data presented shows the level of success achieved in Qld in case holding and cure of tuberculosis. The success rate of the TB treatment programme at the community level contributes significantly to the overall outcome of TB control in Qld and the quality control of this is maintained by the ongoing data base collection, particularly with regard to detecting changing anti-mycobacterial drug resistance patterns of organisms that signify lowered standard of TB treatment. 378-PCll A Comparison of the Tuberculosis Control Programs in San Francisco, USA and Ziirich, Switzerland Shang, H. 1, Rose, N. 1, Brdndli, 0.1, Schecter, G.2 1Ziircher Hig'henklinik Wald, CH-8639 Wald, CH-8639 Faltigberg-Wald, Switzerland; 2TB Clinic, San Francisco General Hospital, San Francisco, USA
San Francisco county and the canton of Ztirich are suited for comparison of their TB control programs, being comparable in population, with significant numbers of HIV-infection, employing long established, well functioning, though differently organized TB management programs, showing low drug resistance rates and having patient populations consisting of 50% and more foreigners. Beside these similarities San Francisco had a TB incidence in 1992 of 49 cases/100'000, with HIV involvement in 23%, whereas Ztirich had only 15 cases/ 100'000, with HIV involvement in 12%. The outcome and management of 355 active TB cases treated in San Francisco 1992 will be compared with 325 cases treated in Ztirich 1991 and 1992, regarding their cure and relapse rates, rates of known bacteriologic conversion, compliance, HIV serology and patient habits concerning intravenous drug abuse and alcoholism. Furthermore the socio-economic background of the Ztirich patients will be analyzed in regard to household size, employment, income and homelessness in order
79
to better characterize the populations mainly suffering from tuberculosis. Use of DOT, and doctor as well as patient compliance in regard to preventive chemotherapy will also be compared in both cities.
400-PCll Fate of smear positive pulmonary tuberculosis patients in Turkey Kocaba~, A., Burgut, R., Kibaro~lu, E., Seydao~lu, G., Bozdemir, N. ~ukurova University School of Medicine, Adana, Turkey
To assess the effectiveness of tuberculosis treatment programme conducted by 253 antituberculosis dispensaries in Turkey, we investigated the results of treatment in all smear positive pulmonary tuberculosis patients (> 15 years old) without known history of treatment, notified by dispensaries in January and February of 1990 retrospectively. A survey form was developed to get information on treatment outcome for each patient notified and sent to the physicians in charge of each dispensary in March 1992, two years after the last patient notified. Of the total 404 patients studied, 319 (21%) were women, 376 (93.1%) were under 60 years old, 221 (54.7%) had cavitary lesion(s) on their pretreatment chest X-ray and 377 (93.3%) had no additional diseases. All patients were put under nine months short course chemotherapy regimen (2RIZS(E) + 7RI) and 220 of them (54.5%) took their initial treatment at hospital for 1-3 months. At the 9th month of chemotherapy, only 14.6% of patients were stable (completed chemotherapy as planned but smear examination was not performed), 22.8% of them were lost to follow-up, 57.8% of them were still under treatment and 1.2% of them had died. The rate of stable patients was 41.5% at 12th month and 69.8% at 24th month. We conclude that treatment programme conducted by dispensaries under mass condition in Turkey seems unsuccessful and rather behind the objectives of WHO.
249-PCll Outcome of patients treated for pulmonary TB in Vaud County Coulon, P., Zellweger, J.P. TB Unit, University Medical Policlinic, 1005 Lausanne, Switzerland
Aim: To assess the outcome of patients treated for pulmonary TB by general practitioners or chest physicians in Vaud county. Method: Retrospective analysis, by postal questionnaire to the practitioners, of all patients notified for culturepositive pulmonary TB in 1988, 1990 and 1992. Results: 133 patients were notified for TB. Follow-up information was available for 120, 17 had died during the time of treatment. Among the 103 evaluable patients, 82 received a treatment for the first time and 21 had already been treated. 84 patients were prescribed at least 6 months of treatment with HR + 2 months of Z, 19 received less than 6 months of treatment or a less active combination.
treatment outcome, and bacteriological resistance of M. tuberculosis isolates.
Results: Of the 847 cases, 620 were bacteriologically +ve (548 of 690 pulmonary TB cases and 72 of 157 nonpulmonary cases), with 267 of 548 bacteriologically +ve pulmonary TB (PTB) cases being sputum smear +ve (a further 54 being smear +ve from bronchial washing without having had microscopy of sputum performed prior to surveillance during treatment). Of the 548 cases of bacteriologically proven PTB, 436 completed treatment (422 adequate treatment, 14 irregular treatment) with cure, and there was only one treatment failure. Of the remaining 111, 38 emigrated from Qld and were properly referred to clinicians outside of Qld, while three were lost to follow up. The remaining 70 were either post mortem notifications (11) or deceased before commencing (l) or during TB treatment (58). Of the 58 dying during TB treatment, 16 died due to TB and 42 with TB. Conclusion: The data presented shows the level of success achieved in Qld in case holding and cure of tuberculosis. The success rate of the TB treatment programme at the community level contributes significantly to the overall outcome of TB control in Qld and the quality control of this is maintained by the ongoing data base collection, particularly with regard to detecting changing anti-mycobacterial drug resistance patterns of organisms that signify lowered standard of TB treatment. 378-PCll A Comparison of the Tuberculosis Control Programs in San Francisco, USA and Ziirich, Switzerland Shang, H. 1, Rose, N. 1, Brdndli, 0.1, Schecter, G.2 1Ziircher Hig'henklinik Wald, CH-8639 Wald, CH-8639 Faltigberg-Wald, Switzerland; 2TB Clinic, San Francisco General Hospital, San Francisco, USA
San Francisco county and the canton of Ztirich are suited for comparison of their TB control programs, being comparable in population, with significant numbers of HIV-infection, employing long established, well functioning, though differently organized TB management programs, showing low drug resistance rates and having patient populations consisting of 50% and more foreigners. Beside these similarities San Francisco had a TB incidence in 1992 of 49 cases/100'000, with HIV involvement in 23%, whereas Ztirich had only 15 cases/ 100'000, with HIV involvement in 12%. The outcome and management of 355 active TB cases treated in San Francisco 1992 will be compared with 325 cases treated in Ztirich 1991 and 1992, regarding their cure and relapse rates, rates of known bacteriologic conversion, compliance, HIV serology and patient habits concerning intravenous drug abuse and alcoholism. Furthermore the socio-economic background of the Ztirich patients will be analyzed in regard to household size, employment, income and homelessness in order
79
to better characterize the populations mainly suffering from tuberculosis. Use of DOT, and doctor as well as patient compliance in regard to preventive chemotherapy will also be compared in both cities.
400-PCll Fate of smear positive pulmonary tuberculosis patients in Turkey Kocaba~, A., Burgut, R., Kibaro~lu, E., Seydao~lu, G., Bozdemir, N. ~ukurova University School of Medicine, Adana, Turkey
To assess the effectiveness of tuberculosis treatment programme conducted by 253 antituberculosis dispensaries in Turkey, we investigated the results of treatment in all smear positive pulmonary tuberculosis patients (> 15 years old) without known history of treatment, notified by dispensaries in January and February of 1990 retrospectively. A survey form was developed to get information on treatment outcome for each patient notified and sent to the physicians in charge of each dispensary in March 1992, two years after the last patient notified. Of the total 404 patients studied, 319 (21%) were women, 376 (93.1%) were under 60 years old, 221 (54.7%) had cavitary lesion(s) on their pretreatment chest X-ray and 377 (93.3%) had no additional diseases. All patients were put under nine months short course chemotherapy regimen (2RIZS(E) + 7RI) and 220 of them (54.5%) took their initial treatment at hospital for 1-3 months. At the 9th month of chemotherapy, only 14.6% of patients were stable (completed chemotherapy as planned but smear examination was not performed), 22.8% of them were lost to follow-up, 57.8% of them were still under treatment and 1.2% of them had died. The rate of stable patients was 41.5% at 12th month and 69.8% at 24th month. We conclude that treatment programme conducted by dispensaries under mass condition in Turkey seems unsuccessful and rather behind the objectives of WHO.
249-PCll Outcome of patients treated for pulmonary TB in Vaud County Coulon, P., Zellweger, J.P. TB Unit, University Medical Policlinic, 1005 Lausanne, Switzerland
Aim: To assess the outcome of patients treated for pulmonary TB by general practitioners or chest physicians in Vaud county. Method: Retrospective analysis, by postal questionnaire to the practitioners, of all patients notified for culturepositive pulmonary TB in 1988, 1990 and 1992. Results: 133 patients were notified for TB. Follow-up information was available for 120, 17 had died during the time of treatment. Among the 103 evaluable patients, 82 received a treatment for the first time and 21 had already been treated. 84 patients were prescribed at least 6 months of treatment with HR + 2 months of Z, 19 received less than 6 months of treatment or a less active combination.