THE TB TREATMENT OUTCOMES in the Piedmont area in Italy, described in this issue of the Journal, illustrate that TB control in low-incidence countries
continues to pose signifi cant problems.1 The low reported treatment success rate of 56.5% in new pulmonary cases is far below the targets set by the World Health Organization of 85% cure, while the staggeringly high level of unsuccessful outcome, 36.8%, is unacceptable and may create subsequent problems with drug resistance, which was not studied in this report. For Western European countries, the respective outcome results are on average 78% and 19% (of which 3% are still on treatment).2 It is time that Italy—and others not included in the EuroTB report—heed the call to report their outcomes. Poor outcomes across Western Europe are generally associated with a loss to follow-up in excess of 10%, especially among patients of foreign origin, and elderly patients, who are more frequent in the national population.2 A nomogram has now been proposed to predict those at risk of unfavourable outcome.
Treatment outcome monitoring is a public health strategy for evaluating the effi cacy of the set of interventions that contribute to a successful outcome of case management. Some clinicians justify the failure to report outcomes on the basis that non-standardised treatment has been used. As it is important to include all cases in outcome monitoring, even those who have not been treated, such as those diagnosed post mortem, ‘case management monitoring’ would have been a better label.