Improve therapy adherence for successful Tuberculosis treatment outcome 

Germany has a low incidence of tuberculosis (TB). However, the relatively high number of treatment relapses among TB patients indicates suboptimal treatment adherence and a suboptimal healthcare structure. The No1Lost project, a comprehensive collaborative initiative funded by the Federal Ministry of Health (BMG), aims to enhance TB treatment care in a targeted manner. This will be achieved by establishing a “treatment adherence competence network” and conducting research into relevant risk factors. The project’s primary focus is a prospective cohort study, which is being conducted in collaboration with the German Central Committee against Tuberculosis (DZK eV), the Justus Liebig University in Giessen and the CAPNETZ STIFTUNG.

TB is considered a less frequent infectious disease in Germany, the number of cases has been increasing recently. Despite the availability of effective drugs, there are a number of challenges associated with treatment, including resistance to anti-TB drugs and severe side effects, which can lead to poor adherence or premature discontinuation of treatment, resulting in clinical deterioration in individuals.  

The effectiveness of TB treatment is strongly influenced by social and socio-economic conditions, which also affect adherence. Several factors have been suggested to determine the outcome of comprehensive TB care. For example, a preparatory study showed that clinical care currently depends heavily on the individual commitment of the specialists involved, and that socio-medical support is often underfunded. One of the objectives is therefore to improve adherence to TB treatment by establishing a socio-medical TB competence network with a registry. 

Cohort study to identify risk factors for treatment discontinuation in multidrug-resistant tuberculosis (MDR-TB) and rifampicin-resistant tuberculosis (RR-TB)

The prospective MDR-TB cohort study, which is being conducted as part of the No1Lost joint project, is expected to yield tangible results. The objective of the MDR-TB cohort study is to record and analyze the current clinical and social care structure for MDR-TB patients in German treatment centers. This will be achieved by utilizing data on the course of the disease, the course of therapy, and clinical, structural and socioeconomic risk factors. The results will provide an invaluable foundation for the development of a “treatment adherence competence network,” which will serve as a crucial tool for the long-term enhancement of treatment outcomes for MDR-TB in Germany. It is important to note that the success rate of TB therapies is less than 80%, with multi-drug resistant TB having a success rate between 60 and 70%. This is often caused by treatment discontinuation. The cohort study will also investigate the risk factors for treatment discontinuation, such as a lack of understanding of the disease or a lack of social support and socio-medical services.