Predictors of Loss to Follow-Up among Men with Tuberculosis in Puducherry and Tamil Nadu, India

Zhou, Thomas; Lakshminarayanan, Subitha; Sarkar, Sonali; Knudsen, Selby; Horsburgh, C. Robert; Muthuraj, Muthusivaramapandian; Kan, Carolyn; Salgame, Padmini; Ellner, Jerrold J.; Roy, Gautam; Jenkins, Helen E.; Hochberg, Natasha S.

doi:10.4269/ajtmh.19-0415

Cited by 14 publications

(15 citation statements)

References 34 publications

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“…Psychosocial factors also emerged as important barriers to adherence. Alcohol use was significantly associated with non-adherence, consistent with findings from previous Indian studies showing poorer TB treatment outcomes in patients with alcohol use disorder [34,35]. While we did not formally measure depression, more than one-fifth of patients who reported missing doses described feeling depressed as a major reason.…”

Section: Discussionsupporting

confidence: 84%

Understanding non-adherence to tuberculosis medications in India using urine drug metabolite testing: a cohort study

Subbaraman

Thomas

Kumar

et al. 2021

Preprint

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BackgroundSuboptimal adherence to tuberculosis (TB) treatment is associated with increased disease recurrence and death. Little research has been conducted in India to understand TB medication non-adherence.MethodsWe enrolled adult drug-susceptible TB patients, about half of whom were people living with HIV (PLHIV), in Chennai, Vellore, and Mumbai. We conducted a single unannounced home visit to administer a survey assessing reasons for non-adherence and collect a urine sample that was tested for isoniazid content. We described patient-reported reasons for non-adherence and identified factors associated with non-adherence (negative urine test) using multivariable logistic regression. We also assessed the association between non-adherence and unfavorable treatment outcomes.ResultsOf 650 patients in the cohort, 77 (11.8%) had a negative urine test result. Non-adherence was independently associated with daily wage labor (aOR 3.1, CI: 1.3—7.7), smear-positive pulmonary disease (aOR 2.1, CI: 1.1—4.1), alcohol use (aOR 2.3, CI: 1.1—4.8), and spending 60 minutes or more picking up medication refills (aOR 9.1, CI: 1.8—45.4). PLHIV reported greater barriers to picking up medications than non-PLHIV. Among 167 patients who reported missing doses, common reasons reported included traveling away from home, forgetting, feeling depressed, and running out of pills. The odds of non-adherence was 3.8 (CI: 2.1—6.9) times higher among patients with unfavorable treatment outcomes compared to those with favorable outcomes.ConclusionAddressing structural and psychosocial barriers will be critical to improve TB treatment adherence in India. Urine isoniazid testing may help identify non-adherent patients to facilitate early intervention during treatment.Key pointsWe evaluated adherence to tuberculosis medications in 650 Indian patients by conducting urine isoniazid tests collected during unannounced home visits. Structural barriers to collecting medication refills and psychosocial barriers emerged as the most important factors contributing to medication non-adherence.

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Section: Discussionsupporting

confidence: 84%

Understanding non-adherence to tuberculosis medications in India using urine drug metabolite testing: a cohort study

Subbaraman

Thomas

Kumar

et al. 2021

Preprint

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“…This indicates that re-treated patients with TB should be given more health education and follow-up reminders when they are consulted in an outpatient clinic, especially before treatment starts. In addition, the higher frequency of LTFU in re-treated patients may be attributed to psychological distress, lack of social support, stigma, and negative attitudes toward treatment in other studies (17,22,23). Patients who have a previous history of TB were also one of the highest risk factors for DR TB (24).…”

Section: Discussionmentioning

confidence: 93%

“…Individuals who are not registered residents of Shenzhen or have not lived in Shenzhen for more than 6 months are considered as migrant population.” ( 17 ).…”

Section: Methodsmentioning

confidence: 99%

Factors associated with loss to follow-up before and after treatment initiation among patients with tuberculosis: A 5-year observation in China

et al. 2023

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BackgroundLoss to follow-up (LTFU) is a significant barrier to the completion of anti-tuberculosis (TB) treatment and a major predictor of TB-associated deaths. Currently, research on LTFU-related factors in China is both scarce and inconsistent.MethodsWe collected information from the TB observation database of the National Clinical Research Center for Infectious Diseases. The data of all patients who were documented as LTFU were assessed retrospectively and compared with those of patients who were not LTFU. Descriptive epidemiology and multivariable logistic regression analyses were conducted to identify the factors associated with LTFU.ResultsA total of 24,265 TB patients were included in the analysis. Of them, 3,046 were categorized as LTFU, including 678 who were lost before treatment initiation and 2,368 who were lost afterwards. The previous history of TB was independently associated with LTFU before treatment initiation. Having medical insurance, chronic hepatitis or cirrhosis, and providing an alternative contact were independent predictive factors for LTFU after treatment initiation.ConclusionLoss to follow-up is frequent in the management of patients with TB and can be predicted using patients’ treatment history, clinical characteristics, and socioeconomic factors. Our research illustrates the importance of early assessment and intervention after diagnosis. Targeted measures can improve patient engagement and ultimately treatment adherence, leading to better health outcomes and disease control.

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“…In the current study, 83.4% of patients were LTFU during the intensive phase (month 1 -66.7%, month 2 -16.7%). This finding is higher than the 24/55(43%) of LTFU reported in the first two months of initiating DOTS in India [14]. Also, Shaweno et al who evaluated the difference in LTFU among patients who took anti-TB in a primary health centre versus general hospital noted that 65% of LTFU occurred during the intensive phase [15].…”

Section: Discussionmentioning

confidence: 81%

Timing and reasons for lost to follow-up among patients on 6-month standardized anti-TB treatment in Nigeria

Adepoju¹,

Adelekan²,

Adejumo³

2022

J Pre Clin Clin Res.

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Introduction andObjective. Loss to follow-up (LTFU) along the TB care cascade is a barrier to TB control because of sustained TB transmission including resistant strains, high mortality and increased spread of DRTB strains. Understanding common reasons for LTFU and their timing could help target interventions to improve adherence to TB treatment. Materials and method. A cross-sectional study using pre-tested questionnaires were administered by phone interviews to 90 TB patients receiving treatment between January -December 2020 who were LTFU while on TB treatment in 31 health facilities across three States in South West Nigeria. The focus of the interviews was to determine the reasons why they were LTFU. Interviewers contacted treatment supporters when patients could not be reached. Clinical and socio-demographic information, such as age, sex and HIV status were extracted from treatment registers Results. The mean age of patients was 42.6 years (16-90) and SD=17.2. The majority 73 (81%) of LTFU were male, while Ogun State had the highest number -35 (38.9%), LTFU was highest during the first month on treatment -60 (66.7%), among HIV negative -63 (70%), and those who had not been treated previously for TB -85 (94.4%). The most common reason for LTFU among TB patients on treatment was death -23(25.6%), followed by lack of transport -16 (17.8%), and religious beliefs -12 (13.3%). Conclusions. The study suggests a high mortality among patients receiving treatment who may have been classified as LTFU. Interventions to reduce mortality and increase coverage of TB treatment facilities, thus bringing care closer to patients, is necessary. It is suggested that 30-day adherence calendars should be used to improve adherence counselling in the first one month on treatment to minimize early LTFU among TB patients.

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Predictors of Loss to Follow-Up among Men with Tuberculosis in Puducherry and Tamil Nadu, India

Cited by 14 publications

References 34 publications

Understanding non-adherence to tuberculosis medications in India using urine drug metabolite testing: a cohort study

Understanding non-adherence to tuberculosis medications in India using urine drug metabolite testing: a cohort study

Factors associated with loss to follow-up before and after treatment initiation among patients with tuberculosis: A 5-year observation in China

Timing and reasons for lost to follow-up among patients on 6-month standardized anti-TB treatment in Nigeria

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