Treatment outcomes of Pulmonary Tuberculosis in İstanbul , Turkey

1. Treatment outcomes of Pulmonary Tuberculosis in İstanbul, Turkey AylinBabalık, ZekiKilicaslan, S. Sevkan Caner, GökayGüngör, M. GönençOrtaköylü, SerapGencer, Stephen A. McCurdy Turkish Thoracic Society 15th Annual Congress April 11-15 2012

2. There is not conflict of interest

3. TB incidence (cases per 105 per year) • Gümüşlü F, Özkara Ş, Özkan S, Baykal F, Güllü Ü. Türkiye’de Verem Savaşı 2008 Raporu. Verem Savaşı Dairesi Başkanlığı. Ankara, 2008. • Bozkurt H, Türkkanı MH, Musaonbaşıoğlu S, et al. Türkiye’de Verem Savaşı 2009 Raporu. Verem Savaşı Dairesi Başkanlığı. Ankara, 2009. • Bozkurt H, Türkkanı MH, Musaonbaşıoğlu S, Yıldırım A, Baykal F, Özkara Ş. Türkiye’de Verem Savaşı 2010 Raporu. Verem Savaşı Dairesi Başkanlığı. Ankara, 2010 • . Bozkurt H, Türkkanı MH, Musaonbaşıoğlu S, Yıldırım A, Baykal F. Türkiye’de Verem Savaş Raporu 2011. Verem Savaşı Dairesi Başkanlığı. Ankara, 2011.

4. Treatment outcome according to years, in Turkey

5. OBJECTIVES • Describe the outcome of treatment (success vs poor outcome) of pulmonary TB patients treated with short-course chemotherapy in Istanbul. • Characterize patients with respect to demographic factors(age, sex) and clinical characteristics (year of diagnosis, country of birth, previous treatment, extrapulmonary involvement, initial smear and culture results, Resistance (sensitive, H alone, R +/- others (except H), H & R +/- others)) • Analyses forfactors affecting of treatment outcome

6. EXPOSURES & OUTCOMES • PoorOutcome • Failure, died, default • FavorableOutcome • Cured, Completed Treatment • EXPOSURES • Demographic characteristics • Sex , Age • Clinical characteristics • Year of diagnosis, • Country of Birth, • Previous treatment, • Extrapulmonary involvement, • initial smear and culture results, Resistance • (sensitive, H alone, R +/- others (except H), H & R +/- others))

7. STUDY DESIGN /Study Setting Study Design: Descriptive historical cohort study Setting: TB patients receiving treatment between 1st January 2006 and 31st December 2009 at TB dispensaries in Istanbul with one-year follow up to determine treatment outcome.

8. Study Population Begining Subjects: 24,841 . Inclusion criteria: • smear- or culture-positive M. tuberculosis pulmonary TB • ≥ 18 years Exclusion criteria: • persons younger than 18 years of age (n=2624) • patients with extrapulmonary-only TB (n=5,584) • lack of information on treatment outcome (n=1656) • disease caused by atypical Mycobacteria (n=257) • negative results for both smear and culture (n=3249) • MDR TB treated with second-line agents (n=19) • unknown previous treatment history (n=266) Total Study Population: 11,186 patients

9. DATA HANDLING and Statistical Analysis • Data from the registry were provided in digital format and analyzed using the Statistical Program for the Social Sciences software package, SPSS 16.0 (IBM SPSS; Armonk, New York). • We randomly chose 20 cases from the computerized database to check against the original registry and found 100% concordance for all data elements. • Continuous variables are summarized using mean and standard deviation or median and quartiles. Final analysis employed multivariate logistic regression yielding odds ratios for the association between risk factors and adverse outcomes with adjustment for age category and history of previous treatment.

10. TB registry/TB Treatment • 32 TB dispensaries in Istanbul • Each collaborates with one of two main diagnostic laboratories subject to external quality control from the national TB reference laboratory in Ankara. • Data elements for the Turkish national TB program are based on the World Health Organization’s Centralized Information System for Infectious Diseases (WHO-CISID) data standards, EuroTB data file. • All TB patients were treated according to the Turkish National TB Guidelines at the dispensaries • Treatment outcome was evaluated 12 months after the commencement of the TB treatment in the cohort. • Bozkurt H, Türkkanı MH, Musaonbaşıoğlu S, Yıldırım A, Baykal F. Türkiye’de Verem Savaş Raporu 2011. Verem Savaşı Dairesi Başkanlığı. Ankara, 2011. • Özkara S, Aktaş Z, Özkan S, Ecevit H. Türkiye’de tüberkülozun kontrolü için başvuru kitabı. Verem Savaşı Dairesi Başkanlığı. Ankara, 2003.

15. Limitations/Strengths Strengths: • In Istanbul, site of the nation’s highest incidence of TB. • All eligible patients within the city catchment area, minimizing the effect of selection bias. • Goodprecisionforexamining subgroups of patients Limitations: • Solely adult patients and those with available data for prior treatment history and treatment outcome • TB patients not detected by the national health system are not included, such as thehomeless.

16. CONCLUSIONS • Patients with characteristics such as advanced age, male sex, birth outside of Turkey, and prior treatment history should be considered at high risk for adverse outcomes, warranting increased vigilance and care. • Prior treatment history is especially valuable in foreshadowing problems likely to ensue with current therapy, especially treatment default and failure. • Prevalence of antibiotic resistance serves as an indicator of community as well as individual health, warning of the need for further resources and attention. • In particular, patients with MDR merit agressive attention to avoid treatment failure and death and establishment of MDR strains in the population.