Team-based, hybrid, or standard of care? Organizational models of tuberculosis care on tuberculosis outcomes in eleven Italian hospital

Objectives: Tuberculosis (TB) continues to pose challenges in high-income countries, among migrant and socioeconomically vulnerable populations. Treatment discontinuity and loss to follow-up (LTFU) remain critical barriers to TB control. This study evaluated the impact of three organizational models of TB care on clinical and programmatic outcomes in Italy. Methods: We conducted a multicenter study including all TB patients diagnosed between 2021 and 2024 in 11 hospitals in five regions. Centers were categorized into three care models: (i) TB-Team (structured care with trained staff, dedicated outpatient clinics, and proactive follow-up); (ii) Hybrid center (HC); and (iii) Standard of Care (SOC). Primary outcomes included hospital length of stay, incidence and severity of adverse events, treatment completion, and LTFU. Mixed-effect regression models adjusted for confounders. Results: Of 717 pan-susceptible and mono-resistant TB patients, 375 (52.3%) were treated in TB-team centers, 175 (24.4%) in HC, and 167 (23.3%) in SOC centers. Treatment completion was higher in TB-team (327/375, 87.2%) vs. HC (116/162, 71.6%) and SOC centers (89/158, 56.3%) (p<0.0001), while LTFU was lowest in TB-team (35/375, 9.3%) vs. HC (44/162 27.2%) and SOC (63/158, 39.9%) (p<0.0001). Hospital stay was shorter in TB-team (median 26 days, IQR 15-55) and HC (35 days, IQR 22-62) compared to SOC (50 days, IQR 22-82) (p<0.0001). The occurrence of adverse events was similar (p=0.54), with lower severity in TB-team and HC. Adjusted analyses confirmed lower risk of incomplete treatment (OR 0.10, 95% CI 0.03 to 0.30), LTFU (OR 0.09, 95% CI 0.04 to 0.23) and severe adverse events (OR 0.40, 95% CI 0.17 to 0.95) in TB Team vs. SOC. Conclusions: The TB-dedicated care model was associated with improved outcomes, fewer severe adverse events, higher treatment completion rates, and lower LTFU. While hybrid models conferred intermediate benefit, implementation of TB care ensured consistent gains. These findings support scaling up TB team-based models to strengthen TB control and align with elimination targets.