Outcome of patients treated for tuberculosis in Vaud County, Switzerland.

SETTING: The outcome of tuberculosis treatment is often not assessed in low-incidence countries such as Switzerland. In economically developed countries, private practitioners do not have the final responsibility for ensuring the completion of adequate tuberculosis treatment, and public health officers have little or no legal means of intervening if they are not specifically requested to do so. Furthermore, the reluctance of private practitioners to follow official guidelines may be an obstacle to the implementation of a regular surveillance policy. OBJECTIVE: To assess the results of treatment in patients with culture-positive pulmonary tuberculosis and to identify the risk factors for non-adherence to treatment. DESIGN: Retrospective study of all cases notified between 1988 and 1992 in Vaud County, and mainly treated by independent 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 adequate treatment) was observed in 84 patients (70%), 17 died (14%) and 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, compared with 3/84 (4%) among adherent patients. CONCLUSION: The outcome of treatment in this group of patients does not correspond to the expected standards: the treatment completion rate was too low, and the default rate was too high. Better education of medical staff and health-care workers, use of directly-observed treatment, and regular surveillance of treatment outcome will be necessary to improve the results