Monitoring treatment outcomes in patients with chronic disease: lessons from tuberculosis and HIV/AIDS care and treatment programmes

Abstract

There are 2 types of chronic disease. First, there is the chronic disease that can be cured after a period of several months or several years, tuberculosis being the classical prototype with drug-sensitive disease requiring 6 months of antituberculosis treatment and drug-resistant disease requiring treatment for up to 2 years. In tuberculosis, although cure is defined programmatically and is based on patients completing treatment with negative bacteriology, many patients may be left chronically disabled with residual symptomatic lung damage. Second, there is the chronic disease that cannot be cured and requires lifelong indefinite treatment, examples being HIV/AIDS and non-communicable diseases such as diabetes mellitus, chronic obstructive airways disease and cardiovascular disease. Ever since the ‘DOTS TB Strategy Framework’ was launched in 1994, tuberculosis control programmes all over the world have monitored, recorded and reported on the treatment outcomes of patients registered for treatment. At the district, provincial and national level, the reporting is done quarterly – there is the ‘quarterly cohort report of case finding’ recording all patients registered within a specific geographic area, stratified by type and category of disease, and 12 months later there is the ‘quarterly cohort report of treatment outcomes’ recording what has happened to each of these patients according to well-established, standardised definitions. This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)