title: Recurrence of tuberculosis in a low-incidence setting without directly observed treatment: Victoria, Australia, 2002-2014.
abstract: Victoria, Australia, is an industrialised setting with low tuberculosis (TB) incidence and universal health care. Individually tailored adherence support for self-administered daily anti-tuberculosis treatment is provided. Directly observed treatment (DOT) is very rarely used.
  
  
  
  To review the rate of recurrent TB in Victoria between 2002 and 2014.
  
  
  
  This was a retrospective cohort study. All recurrent episodes of TB were reviewed and 24-locus MIRU-VNTR (mycobacterial interspersed repetitive units-variable number of tandem repeats) molecular typing was used where possible to determine the likelihood of relapse or reinfection.
  
  
  
  Of 4766 notifications, 32 (0.7%) were recurrent episodes. Of 20 episodes that occurred in patients who had previously completed treatment, 11 were culture-positive (0.4% of 3012 culture-positive episodes): 9 were likely relapses (distinguishable at no more than one of 24 loci) and two were likely reinfections, giving a TB relapse rate among culture-positive episodes of 52.5/100 000 person-years (mean time to study end per patient of 5.7 years). The median time until relapse was 18 months (interquartile range 12-30).
  
  
  
  The low rate of relapse in our setting demonstrates that individually tailored adherence support for self-administered anti-tuberculosis treatment can achieve excellent treatment outcomes.
authors.affiliation: Victorian Tuberculosis Program, Parkville.
authors.forename: K D
authors.initials: KD
authors.lastname: Dale
authors.affiliation: Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Melbourne.
authors.forename: M
authors.initials: M
authors.lastname: Globan
authors.affiliation: Department of Health and Human Services, Melbourne.
authors.forename: E L
authors.initials: EL
authors.lastname: Tay
authors.affiliation: Victorian Tuberculosis Program, Parkville, School of Public Health and Preventive Medicine, Monash University, Clayton.
authors.forename: J M
authors.initials: JM
authors.lastname: Trauer
authors.affiliation: Victorian Tuberculosis Program, Parkville.
authors.forename: P G
authors.initials: PG
authors.lastname: Trevan
authors.affiliation: Victorian Tuberculosis Program, Parkville, Department of Microbiology and Immunology, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: J T
authors.initials: JT
authors.lastname: Denholm
mesh_terms: D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D018598:Minisatellite Repeats / Q000235:genetics; D058889:Molecular Typing; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D012008:Recurrence; D012189:Retrospective Studies; D012646:Self Administration; D013997:Time Factors; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology; D014739:Victoria / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents