title: Factors associated with declining numbers of chronic tuberculosis excretors in Japan.
abstract: METHODS
  Japan's National Tuberculosis Programme (NTP).
  
  
  OBJECTIVE
  To determine and assess the chronological change of chronic excretors.
  
  
  METHODS
  We compared two groups of chronic excretors (continuous excretion of TB bacilli in the last 2 years) classified by time of registration; the first group was registered from 1991 to 1997, and the second from 1998 to 2004. The epidemiological situation and the NTP were also compared.
  
  
  RESULTS
  There were 481 cases in the first group, comprising 0.17% of registered cases, and 159 cases in the second group, comprising 0.06%. Stratified analysis by treatment regimen and TB category confirmed a decrease in the ratio of chronic excretors in all sub-groups. Human factors such as non-adherence, no drug susceptibility testing (DST) on initiation of treatment and inadequate modification of treatment in new sputum smear-positive cases were more frequent in the first group than in the second (37.0% vs. 28.9%, 19.5% vs. 10.7%, 36.8% vs. 19.5%, P < 0.05). Other known risk factors, such as interruption due to side effects and complication of diabetes and/or alcoholism, were similarly distributed.
  
  
  CONCLUSIONS
  The decline in chronic excretors has been associated with the DOTS strategy, baseline DST and appropriate modification of treatment regimen in new sputum smear-positive cases.
authors.affiliation: Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan. hhoshino@jata.or.jp
authors.forename: H
authors.initials: H
authors.lastname: Hoshino
authors.forename: K
authors.initials: K
authors.lastname: Uchimura
authors.forename: S
authors.initials: S
authors.lastname: Kato
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023801:Directly Observed Therapy; D019538:Health Care Surveys; D006801:Humans; D007564:Japan / Q000453:epidemiology; D055118:Medication Adherence; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D009313:National Health Programs; D015995:Prevalence; D015397:Program Evaluation; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology*; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents