Pre-treatment lost to follow up among presumptive tuberculosis patients in a tertiary care centre, South India

Abstract

Background: At tertiary care centres, presumptive tuberculosis (TB) patients who come from far off places and are more likely to drop out during diagnosis or before treatment initiation. We aimed to describe the proportion lost during diagnosis or before treatment and also assessed the reasons for the loss to follow up.Methods: We did a hospital based descriptive study, reviewing laboratory register and referral register to assess the status of submission of second sputum and referral letter, respectively, for patients visiting a designated microscopy centre at a teaching hospital. Reasons for lost to follow up were assessed through telephonic interviews.Results: Out of a total 2025 presumptive TB patients, 315 (15.6%, 95% CI 14.0-17.2) did not provide a second sputum sample. ‘Symptoms had reduced or subsided’ (30%), ‘not aware that second sample needs to be given’ (23%) and ‘visited other hospital’ (14%) were the common reasons reported for the same. A total of 270 (13.3%) patients were sputum smear positive; of them 92 (34.1% CI 28.4-40.1) did not collect referral letter. Among those who were referred, 66% were referred within a week. Deaths, ‘busy in routine work’ and treatment at other government hospitals were the common reasons reported for not collecting referral letter.Conclusions:One out of seven patients did not submit a second sputum sample and one third of sputum smear positive TB patients did not collect the referral letter. Follow up mechanisms needs to be strengthened in the national program to reduce this pre-treatment lost to follow up.

Effect of mobile voice calls on treatment initiation among patients diagnosed with tuberculosis in a tertiary care hospital of Puducherry

“…A previous study done in the same setting had shown that only two thirds of the diagnosed TB patients are referred for treatment initiation, and there was a substantial delay between the diagnosis and the referral. [ 26 ] Although the mobile call reminders reduced the delay between the patient referral and the treatment initiation, there was no significant reduction in the overall delay between diagnosis and treatment initiation. This is rightly so, as the mobile voice call reminders were given only after referring the patient for treatment initiation.…”

Development and validation of a risk prediction model for pulmonary tuberculosis among presumptive tuberculosis cases in Ethiopia

“…In low and middle-income countries like Ethiopia, pretreatment loss to follow-up ranges from 4% to 38%. [6][7][8][9] Moreover, 30% of patients with presumptive TB are lost during the diagnosis process. 10 Passive case-finding is the main approach currently applied by most national TB control programmes, including Ethiopia.…”