Does time to loss to follow-up differ among adult tuberculosis patients initiated on tuberculosis treatment and care between general hospital and health centers? A retrospective cohort study

Abstract

Background: Patients' loss to follow-up (LTFU) from tuberculosis treatment and care is a growing worry in Ethiopia. But, available information is inadequate in assessing the time to tuberculosis patient loss to follow-up difference between health centers and a general hospital in Ethiopia. We aimed to assess time to LTFU difference between health centers and a general hospital in rural Ethiopia. Methods:We conducted a retrospective cohort study from September 2008 to August 2015 and collected data from September 1 to October 02, 2016. A total of 1341 TB patients with known treatment outcomes were included into the study. Log rank test was used to compare the difference in time to TB patient loss to follow-up between health centers and a general hospital, whereas Cox proportional hazard model was used to assess factors associated with time to loss to follow-up in both settings. Results: We reviewed a total of 1341 patient records, and the overall follow-up time was 3074.7 and 3974 person months of observation (PMOs) for TB patients followed at health centers and a general hospital, respectively. The incidence of loss to follow-up rate was 27.3 per 1000 PMOs and 9.6 per 1000 PMOs, at health centers and a general hospital, respectively. From the overall loss to follow-ups that occurred, 55 (65.5%) and 33 (86.8%) of LTFUs occurred during the intensive phase and grew to 78 (92.9%) and 38 (100%) at health center and a general hospital, respectively, at the end of 6-month observation period. Older age (AOR = 1.7, 95%CI, 1.2-2.5, P < 0.001), being a rural resident (AHR = 2.7, 95%CI, 1.6-4.6), HIV reactive (AHR = 2.2, 95%CI, 1.5-3.2), following treatment and care in health center (AHR = 3.38, 95%CI, 2.06-5.53), and living at more than 10 km away from the health facility (AHR = 3.4, 95%CI, 2.1-5.7) were predictors for time to loss to follow-up among TB patients on treatment and care. Conclusion: Time to TB patient loss to follow-up between health centers and a general hospital was significant. Loss to follow-up was high in patients with older age, rural residence, sero positive for HIV, living further from the health facilities, and following treatment and care at health centers. Strengthening the DOTs program with special emphasis on health centers is highly recommended.

Predictors of loss to follow-up among adult tuberculosis patients in Southern Ethiopia: a retrospective follow-up study

“…The study cohort was then categorized into two groups based on the main exposure variable to LTFU, which was the distance that patients had to travel from their permanent residential address to reach a health facility providing TB care. We selected distance traveled as the main exposure variable based on the evidence that it strongly predicted LTFU from TB care [ 13 ].…”

“…The sample size was estimated based on a Log-rank test comparing two survival curves using Schoenfed’s method in Stata version 16. Adult TB patients who traveled a distance of over 10 km [ 13 ] to reach the nearest health facility to receive TB care constituted the exposed group; those who traveled a distance fewer than 10 km constituted the control groups. The assumptions considered were 5% significance level, 90% power, 1:2 allocation ratio (exposed to the unexposed group), and a reference hazard ratio of 1.4 [ 13 ].…”

“…A study by Alene et al based on a big sample where district-level data were obtained from regions in Ethiopia through the health management information system and reported an LTFU rate of 5.5% [ 10 ]. Various pocket studies in Ethiopia also documented LTFU in different parts of Ethiopia: 13.5% in Jimma university teaching hospital [ 12 ], 17.29 per 1000 person-months of observations (PMOs) in public health facilities of Sheka zone [ 13 ], and 9.1% in Jinka [ 14 ]. These rates were substantially higher than the WHO recommended target of less than 5% [ 15 ].…”

Treatment Cure Rate and Associated Factors of Sever Acute Malnutrition 6-59 Month Children Treated in Therapeutic Center in Pawe General Hospital: Nourth Wet Ethiopia

“…Probability of event for those cured patient from sever acute malnutrition groups was with time specific since the study was last 5 years (2015-2019), exp (-ʎt) = exp(-0.5) = 0.6 [17] Similarly, the probability of the event for second group was calculated using exp. ( ʎt *AHR) [17,19]. By using AHR = 0.32.…”

Poor adult tuberculosis treatment outcome and associated factors in Gibe Woreda, Southern Ethiopia: An institution-based cross-sectional study

“…The sample size considered in the original study was 402. The assumptions considered for the sample size calculations were 5% significance level, 90% power, 1:1.6 allocation ratio (exposed group (patients travelled 10 km and above to receive TB treatment) to an unexposed group (patients travelled less than 10 km to receive TB treatment)), and a reference hazard ratio of 1.4 [21] for the association between distance travelled to the nearest health facility and loss-tofollow-up from TB treatment. In the original study, simple random sampling technique per the facilities studied was used to proportionally select TB patients from list of 1211 eligible adult TB patients in the four facilities who received first line TB-treatment between June 2016 and June 2019.…”