Headlines - Treatment Outcomes for Drug-Sensitive Tuberculosis Cases Reported in France, 2008–2014

To mark World Tuberculosis Day, Santé publique France is dedicating a special issue of the BEH to this topic1. An article analyzes treatment outcomes for patients with active tuberculosis, for whom surveillance was introduced as part of mandatory reporting (DO) in France in July 2007. This surveillance makes it possible to identify cases that have completed treatment and are considered cured, and cases that have not completed treatment and, if contagious, may continue to transmit the infection in the community. The article presents national results on treatment outcomes for active tuberculosis cases reported between 2008 and 2014. Patients were classified according to their status within 12 months of treatment initiation based on European definitions. Tuberculosis cases identified as multidrug-resistant (MDR) in the mandatory reporting system were excluded. Information on treatment outcomes was available for 65% of cases, with an improvement in data reporting between 2008 (60%) and 2014 (72%) (p < 0.001). The percentage of departments not providing information was 9% in 2008 and 3% in 2014. During this period, 74.1% of tuberculosis cases, across all clinical forms, completed treatment, with this proportion improving significantly over time (rising from 73.0% in 2008 to 76.9% in 2014, p<0.001). Among pulmonary cases, the proportion of treatment completion was 73.2%, 70.6% among smear-positive pulmonary cases, and 74.0% among culture-positive pulmonary cases. Among these cases, 19.8% had a potentially unfavorable outcome, of which 44% were lost to follow-up, 25% were transferred patients, 13% were patients still undergoing treatment at 12 months, 9% were tuberculosis-related deaths, and 9% were cases that had discontinued and not resumed treatment. The steady decrease in the number of cases with an unknown treatment outcome and the decrease in the number of departments that did not provide information on treatment outcomes indicate improved reporting and possibly better case follow-up. The percentage of patients who completed treatment, which increased over the study period, suggests improved care for these patients.Although these results are encouraging, they are insufficient and fall short of the World Health Organization’s target of at least a 90% cure rate for smear-positive pulmonary cases. They should encourage the various stakeholders to continue and strengthen this surveillance, particularly through the Tuberculosis Control Centers (CLAT), which play a major role in this effort.