2021 State and City TB Report

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Completion of Therapy

Fully treating and, therefore, preventing further spread of M. tuberculosis is key to TB control and elimination. If TB drugs are stopped too soon or not taken correctly, a person may develop symptoms again or drug resistance may develop, enabling the further spread of TB. Each patient is unique. There are many reasons why a patient might be unable or unwilling to complete TB treatment, such as:

  • No longer experiencing symptoms of TB, not fully understanding the treatment regimen
  • Not being willing or able to manage side effects of their treatment regimen
  • Cultural beliefs
  • Language barriers
  • Difficulty getting health care
  • Substance use
  • Mental health issues

Completion of therapy among persons who have experienced homelessness or been incarcerated can be particularly challenging due to difficulty locating patients for follow-up care and treatment, but it is particularly important because of the risk of transmission at shelters or correctional facilities.

Percentage of Newly Diagnosed TB Cases Completing Treatment Less Than or Equal to 12 Months, United States, 2019

Figure 7. Percentage of Newly Diagnosed TB Cases Completing Treatment ≤12 Months, United States, 2019

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  • Directly observed therapy (i.e., patients are observed to ingest each dose of anti-TB medications)
  • Use of incentives and enablers (e.g., gift cards for food or bus fare for transportation to get to and from the health department) to get patients to complete treatment
  • Promoting the shortest appropriate treatment regimen for each patient

TB treatment is complex and can take several months to complete. It can take up to 2 years to have full treatment information reported for each TB patient. As a result, the most recent information available on completion of therapy is from patients in the 50 states and 9 cities who were identified with TB in 2019.

For these patients, 14 states and cities met or exceeded the 2025 national target of 95.0% of eligible patients with TB completing a full treatment regimen in 12 months or less; 18 states and cities were short of the 2025 target but met or exceeded the national average (89.9%) (Figure 7).

Additionally, in 2019 there were 10 states and 4 cities that reported 6 or more TB patients ages 15 years or older who experienced homelessness in the year prior to diagnosis; 10 of these 14 jurisdictions exceeded the national average of 72.4% completion of therapy among TB patients who experienced homelessness (Table 1).

There were 5 states and 4 cities in 2019 that reported 4 or more TB patients ages 15 years or older who were residents of correctional facilities at TB diagnosis; 5 of these 9 jurisdictions exceeded the national average of 72.1% completion of therapy among TB patients residing at correctional facilities (Table 2).

Table 1. Treatment Completion within 12 Months among Newly Diagnosed TB Patients Age ≥15 who Experienced Homelessness within the Year Prior to Diagnosis, United States, 2019

 
States* with 1 to 2 TB patients age ≥15 experiencing homelessness Percentage of patients age ≥15 experiencing homelessness who completed treatment within 12 months^ Percentage of all patients who completed treatment within 12 months† States* with 3 to 5 TB patients age ≥15 experiencing homelessness Percentage of patients age ≥15 experiencing homelessness who completed treatment within 12 months^ Percentage of all patients who completed treatment within 12 months† States* with 6 or more TB patients age ≥15 experiencing homelessness Percentage of patients age ≥15 experiencing homelessness who completed treatment within 12 months^ Percentage of all patients who completed treatment within 12 months†
Colorado 100.0 94.5 Alaska 100.0 90.4 Washington 100.0 93.9
Delaware 100.0 81.3 Alabama 100.0 93.0 Tennessee 100.0 97.3
Kansas 100.0 100.0 Michigan 100.0 95.2 Florida 100.0 97.4
Wisconsin 100.0 97.5 Oregon 100.0 96.8 New Jersey 85.7 92.8
Hawaii 100.0 91.9 Virginia 100.0 93.8 San Francisco 85.7 90.7
Illinois 100.0 92.7 Kentucky 100.0 96.0 Ohio 83.3 85.8
Maryland 100.0 83.4 Arkansas 80.0 87.5 Georgia 82.4 90.0
Arizona 50.0 94.0 Chicago 80.0 93.5 New York City 81.8 90.2
Missouri 50.0 79.0 North Carolina 80.0 89.7 Indiana 80.0 94.4
North Dakota 50.0 75.0 Maine 75.0 87.5 Los Angeles 76.7 87.0
South Carolina 50.0 95.0 Massachusetts 75.0 85.2 California 68.8 89.4
South Dakota 50.0 91.7 New Mexico 66.7 89.2 Texas 67.7 85.4
Baltimore 0.0 84.2 Houston 60.0 94.4 San Diego 65.0 85.5
Pennsylvania 0.0 90.1 Minnesota 50.0 89.5 Mississippi 63.6 89.8
Philadelphia 0.0 88.7 New York 50.0 88.3
District of Columbia 0.0 86.4 Louisiana 25.0 73.7

Table 2. Treatment Completion within 12 Months or Less among Newly Diagnosed TB Patients Age ≥15 who were Residents of Correctional Facilities at the Time of Diagnosis, United States, 2019

 
States* with 1 to 2 TB patients age ≥15 who were incarcerated Percentage of incarcerated patients age ≥15 who completed treatment within 12 months^ Percentage of all patients who completed treatment within 12 months† States* with 3 to 4 TB patients age ≥15 who were incarcerated Percentage of incarcerated patients age ≥15 who completed treatment within 12 months^ Percentage of all patients who completed treatment within 12 months† States* with 5 or more TB patients age ≥15 who were incarcerated Percentage of incarcerated patients age ≥15 who completed treatment within 12 months^ Percentage of all patients who completed treatment within 12 months†
Arkansas 100.0 87.5 Indiana 100.0 94.4 Arizona 100.0 94.0
Chicago 100.0 93.5 North Carolina 100.0 89.7 District of Columbia 87.5 86.4
Colorado 100.0 94.5 Tennessee 100.0 97.3 New York City 80.0 90.2
Connecticut 100.0 92.5 Houston 75.0 94.4 Mississippi 75.0 89.8
Illinois 100.0 92.7 New York 66.7 88.3 San Diego 72.7 85.5
Louisiana 100.0 73.7 Texas 65.8 85.4
Maryland 100.0 83.4 California 62.5 89.4
Michigan 100.0 95.2 Los Angeles 57.1 87.0
Missouri 100.0 79.0 Georgia 37.5 90.0
Ohio 100.0 85.8
West Virginia 100.0 100.0
South Dakota 100.0 91.7
Washington 100.0 93.9
Alaska 0.0 90.4
Baltimore 0.0 84.2
Minnesota 0.0 89.5
New Jersey 0.0 92.8
New Mexico 0.0 89.2
Oklahoma 0.0 82.7

 

Footnotes

Figure 7.  Percentage of Newly Diagnosed TB Cases Completing Treatment ≤12 Months, United States, 2019

The fraction in each parenthesis reports the number of TB patients who completed treatment within 12 months out of the total number of patients who were eligible to complete treatment within 12 months.

States/cities are grouped into thirds based on numbers of TB cases reported in 2019.

Due to the small denominator, data for states that reported 50 or fewer total TB cases should be interpreted with caution.

Data source: National Tuberculosis Surveillance System as of June 14, 2021

Table 1. Treatment Completion within 12 Months among Newly Diagnosed TB Patients Age ≥15  who Experienced Homelessness within the Year Prior to Diagnosis, United States, 2019

*States/cities are grouped into thirds based on numbers of TB cases among persons experiencing homelessness reported in 2019.
^Among those age ≥ 15 years who were eligible to complete treatment within 12 months
†Among all patients of any age who were eligible to complete treatment within 12 months (including those who experienced homelessness in the past year)
Data source: National Tuberculosis Surveillance System as of July 8, 2022

Table 2. Treatment Completion within 12 Months or Less among Newly Diagnosed TB Patients Age ≥15 who were Incarcerated at the Time of Diagnosis, United States, 2019

*States/cities are grouped into thirds based on numbers of incarcerated TB cases reported in 2019.
^Among those age ≥15 years who were eligible to complete treatment within 12 months.
†Among all patients of any age who were eligible to complete treatment within 12 months (including those who were incarcerated at diagnosis).
Data source: National Tuberculosis Surveillance System as of July 8, 2022.