Risk factors associated with loss to follow-up from tuberculosis treatment in Tajikistan: a case-control study

Abstract

BackgroundThere are very few studies on reasons for loss to follow-up from TB treatment in Central Asia. This study assessed risk factors for LTFU and compared their occurrence with successfully treated (ST) patients in Tajikistan.MethodsThis study took place in all TB facilities in the 19 districts with at least 5 TB patients registered as loss to follow-up (LTFU) from treatment. With a matched case control design we included all LTFU patients registered in the selected districts in 2011 and 2012 as cases, with ST patients from the same districts being controls. Data were copied from patient records and registers. Conditional logistic regressions were run to analyse associations between collected variables and LTFU as dependent variable.ResultsThree hundred cases were compared to 592 controls. Half of the cases had migrated or moved. In multivariate analysis, risk factors associated with increased LTFU were migration to another country (OR 10.6, 95% CI 6.12–18.4), moving within country (OR 11.0, 95% CI 3.50–34.9), having side effects of treatment (OR 3.67, 95% CI 1.68–8.00) and being previously treated for TB (OR 2.03, 95% CI 1.05–3.93). Medical staff also mentioned patient refusal, stigma and family problems as risk factors.ConclusionsLTFU of TB patients in Tajikistan is largely a result of migration, and to a lesser extent associated with side-effects and previous treatment. There is a need to strengthen referral between health facilities within Tajikistan and with neighbouring countries and support patients with side effects and/or previous TB to prevent loss to follow-up from treatment.

Determinants of unsuccessful treatment outcomes and mortality among tuberculosis patients in Malaysia: A registry-based cohort study

“…TB cases which were lost to follow-up (5.3% of the total cohort) also warrant significant concern as they are at higher risk for reactivation of active TB, as well as developing MDR-TB [24,25]. Loss to follow-up, or default, is influenced by a myriad of interrelated factors such as patients' beliefs and personal factors, health system and service factors, economics including poverty and gender discrimination as well as the social context in terms of support and TB related stigma [26][27][28].…”

Performance of and Factors Associated With Tuberculosis Screening and Diagnosis Among People Living With HIV: Analysis of 2012–2016 Routine HIV Data in Tanzania

“…Moreover, in 2014, isoniazid prevention therapy (IPT) was introduced in Tanzania for PLHIV attending CTC, with a decline in TB incidence over the 6 years of follow up (23). Conversely, some PLHIV may not have typical symptoms of TB disease and may be missed by the screening, although screening is reported to have a 97% NPV for ruling out TB infection in PLHIV (24). Further analysis of whether low positive TB screening was a reality or due to a weaknesses in the screening process will be evaluated in subsequent analyses.…”

‘They are inconveniencing us’ - exploring how gaps in patient education and patient centred approaches interfere with TB treatment adherence: perspectives from patients and clinicians in the Free State Province, South Africa

“…Studies exploring TB treatment completion generally adopt a bio-medical approach, though TB has long been considered a 'social' disease [8]. Socioeconomic and individual circumstances including patients' sense of feeling better, occupational commitments, side effects, and misinformation on treatment duration impact heavily on treatment completion [9][10][11][12][13][14]. Health education is integrated into services provided at primary health care (PHC) level in South Africa [15].…”