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Publications

Journal Article Epublish

PubMed: 40376187 DOI: 10.1093/ofid/ofaf258

Impact of a TB Team on TB Outcomes: A 2016-2024 Pre-Post Study From a Referral Center in Southern Italy.

Open Forum Infect Dis 12(5):ofaf258

Authors: Francesco Di Gennaro, Sergio Cotugno, Giacomo Guido, Francesco Cavallin, Roberta Papagni, Elda De Vita, Giorgia Manco Cesari, Stefano Di Gregorio, Vincenzo Giliberti, Domenica Cassano, Giuliana Metrangolo, Angela Amendolara, Alessandro Francabandiera, Monica Fiorella, Vittoria Lobalsamo, Gaetano Brindicci, Carmen Rita Santoro, Luigi Ronga, Rossana Lattanzio, Giuseppina De Iaco, Annalisa Saracino

Affiliations

  • Department of Precision and Regenerative Medicine and Jonian Area (DiMePreJ), Clinic of Infectious Diseases, University of Bari Aldo Moro, Bari, Italy.
  • Independent Statistician, Solagna, Italy.
  • Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy.

Abstract

Background

Tuberculosis (TB) remains a major global public health challenge, requiring innovative management strategies to improve patient outcomes and reduce disease burden. Despite advancements in diagnostics and treatment, TB continues to cause significant morbidity and mortality worldwide, particularly among vulnerable populations such as migrants and individuals with limited healthcare access. The World Health Organization has emphasized the need for patient-centered approaches, including the establishment of TB-dedicated teams, to enhance care coordination and improve outcomes. However, real-world evidence on their effectiveness remains limited.

Methods

We conducted a retrospective before-after study to evaluate the impact of a structured TB-dedicated team implemented at a referral hospital in Southern Italy between 2016 and 2024. Prior to 2020, TB care was unstructured, with patients being followed by different physicians without a standardized system. Between 2021 and 2024, a dedicated TB team was established, comprising 2 infectious disease specialists, infectious disease residents, and a senior professor overseeing scientific activities. This new model introduced key interventions, including a dedicated outpatient reservation system, directly observed therapy, structured follow-up, specialist networking, systematic data collection, and targeted counseling on risk behaviors and comorbidities. Primary outcomes included treatment success rates, hospital length of stay, incidence of adverse events, and patient retention in follow-up programs. All tests were 2-sided and a P-value <.05 was considered statistically significant. Statistical analysis was carried out using R 4.4.

Results

A total of 269 TB patients were analyzed (117 pre- and 152 postimplementation). The introduction of the TB team was associated with a significant reduction in loss to follow-up (41.9% to 3.7%; P < .0001; odds ratio, 0.04; 95% confidence interval, .01-.12) and incomplete treatments (41.9% to 12.0; P < .0001; odds ratio, 0.13; 95% confidence interval, .06-.29). Median hospital stay decreased from 28 to 14 days (P < .0001), whereas adverse events remained comparable (32.5% vs 29.6%, P = .71).

Conclusions

The implementation of a TB-dedicated team significantly improved TB management by enhancing treatment adherence, reducing hospitalization, and preventing loss to follow-up. Given the public health impact of TB, structured care models should be prioritized to optimize patient outcomes and strengthen health system efficiency.

MeSH

Confidence Intervals, Public Health, Drug-Related Side Effects And Adverse Reactions, Odds Ratio, Tuberculosis, Therapeutics, Communicable Diseases