Reasons why patients with tuberculosis in South Korea stop anti-TB treatment: a cross-sectional study

Abstract

BACKGROUND: As there had been no reduction in the TB burden in South Korea since 2000, a public-private mix (PPM) strategy was launched in 2011. The purpose of this study was to investigate the reasons for lost to follow-up (LTFU) among TB patients and their clinical characteristics.METHOD: A multicentre, cross-sectional study based on in-depth interviews with patients and their families by TB specialist nurses was conducted. Patients who were reported with a final outcome of LTFU in 2015–2017 at all PPM hospitals across the country were enrolled. Enrolled patients were classified into six subgroups by age and three major reasons for LTFU (adverse effects, refusal of treatment, marginalisation) and their clinical features were compared.RESULTS: Among 780 patients, those who were lost to follow-up due to adverse effects accounted for the largest proportion (n = 387). LTFU in those aged <65 years who refused treatment (n = 189) and those aged <65 years who were marginalised (n = 108) were related to having smear-positive TB and a previous history of unfavourable outcomes.CONCLUSION: To reduce LTFU in South Korea, comprehensive strategies, including management of adverse effects, systematic counselling and education, should be implemented.

Clinical standards for the dosing and management of TB drugs

“…A key aspect of this approach is to provide counselling and education to all TB patients as described in the Clinical Standards. 71 , 98 AEs are a frequent cause of poor adherence, treatment interruption and loss to follow-up. 99 Patients who are aware of potential AEs may be more likely to notify their healthcare team, facilitating more timely management of AEs, potentially reducing the severity of AEs and preventing unfavourable outcomes.…”

“… 115 – 117 When redesigning a TB register, it is recommended to capture data on personalised dosing and TDM, to include a set of core variables which are essential to describe, measure and evaluate the cascade of care in adults, as well as children. 98 Individual data are preferred over aggregated data, but this depends on the local arrangements. As systematic evaluation of drug dosing, as well as of AEs, is relatively easy with the implementation of computerised, individual registers, this should be considered.…”

The importance of knowing why TB patients stop anti-TB treatment

“…Therefore, the paper by Kim et al in this issue of the Journal is relevant and timely. 3 The study describes the reasons for LTFU in 94,872 patients treated in public-private mix (PPM) hospitals in South Korea, where 2957 or 3.1% were LTFU. Out of the surveyed and selected LTFU patients, three major groups emerged based on the reason for abandoning treatment.…”

“…Kim et al reports that one third of the LTFU group was over 65 years of age and linked with adverse events, whereas the younger LTFU patients were more likely to have treatment experience and/or prior negative outcomes. 3 A large global study on adverse events in the treatment of MDR-TB showed that 75% of the patients experiencing side effects had a median age below 53. 4 This indicates that education about TB treatment and prevention of side effects needs to be prioritised, and measures for their management implemented.…”

“…10 Overall, PPM in South Korea has improved outcomes; Kim et al highlight where more effort is required to reduce LTFU. 3 In particular, we need to prevent side effects as much as possible, and encourage the development of an equal partnership between patients and health care workers, so that optimal outcomes can be achieved.…”