Pre-diagnosis and Pre-treatment Loss to Follow-up and Associated Factors Among Patients with Presumed Tuberculosis and Those Diagnosed in Uganda

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2024 Dec 22

PMID 39710664

Authors

Rebecca Nuwematsiko

Noah Kiwanuka

Solomon T Wafula

Mary Nakafeero

Lydia Nakanjako

Henry Luzze

Stavia Turyahabwe

Juliet N Sekandi

Lynn Atuyambe

Esther Buregyeya

Affiliations

Soon will be listed here.

Abstract

Background: Loss to follow-up (LTFU) of patients with presumed tuberculosis (TB) before completing the diagnostic process (pre-diagnosis LTFU) and before initiating treatment for those diagnosed (pre-treatment LTFU) is a challenge in the realization of the End TB Strategy. We assessed the proportion of pre-diagnosis and pre-treatment LTFU and associated factors among patients with presumed TB and those diagnosed in the selected health facilities.

Methods: This was a retrospective cohort study involving a review of routinely collected data from presumptive, laboratory and TB treatment registers from January 2019 to December 2022. The study was conducted in three general hospitals and one lower-level health center IV in Central Uganda. We defined pre-diagnosis LTFU as failure to test for TB and obtain results within 30 days from the date of being presumed and pre-treatment LTFU as failure to initiate TB treatment within 14 days from the date of diagnosis. Modified Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of factors associated with pre-diagnosis and pre-treatment LTFU.

Results: Of the 13,064 patients with presumed TB, 39.9% were aged 25 to 44 years, and 57.1% were females. Almost a third, 28.3% (3,699/13.064) experienced pre-diagnosis LTFU and 13.7% (163/1187) did not initiate treatment within 14 days from being diagnosed. Pre-diagnosis LTFU was more likely to occur among patients aged 0-14 years (adj PR 1.1, 95% CI: 1.06,1.24), females (adj.PR=1.06, 95% CI: 1.01, 1.12) and those with no record of place of residence (adj. PR=2.7, 95% CI: 2.54, 2.93). In addition, patients with no record of phone contact were more likely to be LTFU, (adj. PR=1.1, 95% CI: 1.05, 1.17). Pre-treatment LTFU was also more likely among patients with no record of place of residence (adj PR 7.1, 95% CI: 5.13,9.85) and those with no record of phone contact (adj PR 2.2, 95% CI: 1.63,2.86). Patients presumed from the HIV clinics were 40% less likely to experience pre-treatment LTFU compared to those in the outpatient departments (adj PR 0.6, 95% CI: 0.41,0.88).

Conclusion: High proportions of pre-diagnosis and pre-treatment LTFU were observed in this study. This calls for urgent interventions at these time points in the TB care cascade to be able to realise the End TB Strategy.

References

Ekuka G, Kawooya I, Kayongo E, Ssenyonga R, Mugabe F, Chaiga P . Pre-diagnostic drop out of presumptive TB patients and its associated factors at Bugembe Health Centre IV in Jinja, Uganda. Afr Health Sci. 2020; 20(2):633-640. PMC: 7609087. DOI: 10.4314/ahs.v20i2.11. View

MacPherson P, Houben R, Glynn J, Corbett E, Kranzer K . Pre-treatment loss to follow-up in tuberculosis patients in low- and lower-middle-income countries and high-burden countries: a systematic review and meta-analysis. Bull World Health Organ. 2014; 92(2):126-38. PMC: 3949536. DOI: 10.2471/BLT.13.124800. View

Skov T, Deddens J, Petersen M, Endahl L . Prevalence proportion ratios: estimation and hypothesis testing. Int J Epidemiol. 1998; 27(1):91-5. DOI: 10.1093/ije/27.1.91. View

Zawedde-Muyanja S, Musaazi J, Manabe Y, Katamba A, Nankabirwa J, Castelnuovo B . Estimating the effect of pretreatment loss to follow up on TB associated mortality at public health facilities in Uganda. PLoS One. 2020; 15(11):e0241611. PMC: 7673517. DOI: 10.1371/journal.pone.0241611. View

Shaweno T, Getnet M, Fikru C . 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. Trop Med Health. 2020; 48:9. PMC: 7026974. DOI: 10.1186/s41182-020-00198-8. View

Thomas B, Suresh C, Lavanya J, Lindsley M, Galivanche A, Sellappan S . Understanding pretreatment loss to follow-up of tuberculosis patients: an explanatory qualitative study in Chennai, India. BMJ Glob Health. 2020; 5(2):e001974. PMC: 7053785. DOI: 10.1136/bmjgh-2019-001974. View

Mugauri H, Shewade H, Dlodlo R, Hove S, Sibanda E . Bacteriologically confirmed pulmonary tuberculosis patients: Loss to follow-up, death and delay before treatment initiation in Bulawayo, Zimbabwe from 2012-2016. Int J Infect Dis. 2018; 76:6-13. DOI: 10.1016/j.ijid.2018.07.012. View

Pala S, Bhattacharya H, Lynrah K, Sarkar A, Boro P, Medhi G . Loss to follow up during diagnosis of presumptive pulmonary tuberculosis at a tertiary care hospital. J Family Med Prim Care. 2019; 7(5):942-945. PMC: 6259514. DOI: 10.4103/jfmpc.jfmpc_161_18. View

Jiang Y, Chen J, Ying M, Liu L, Li M, Lu S . Factors associated with before and after treatment initiation among patients with tuberculosis: A 5-year observation in China. Front Med (Lausanne). 2023; 10:1136094. PMC: 10167013. DOI: 10.3389/fmed.2023.1136094. View

10.

Getnet F, Demissie M, Worku A, Gobena T, Tschopp R, Girmachew M . Delay in diagnosis of pulmonary tuberculosis increases the risk of pulmonary cavitation in pastoralist setting of Ethiopia. BMC Pulm Med. 2019; 19(1):201. PMC: 6836413. DOI: 10.1186/s12890-019-0971-y. View

11.

Mulaku M, Nyagol B, Owino E, Ochodo E, Young T, Steingart K . Factors contributing to pre-treatment loss to follow-up in adults with pulmonary tuberculosis: a qualitative evidence synthesis of patient and healthcare worker perspectives. Glob Health Action. 2022; 16(1):2148355. PMC: 9788701. DOI: 10.1080/16549716.2022.2148355. View

12.

Nkereuwem E, Kampmann B, Togun T . The need to prioritise childhood tuberculosis case detection. Lancet. 2021; 397(10281):1248-1249. PMC: 9214637. DOI: 10.1016/S0140-6736(21)00672-3. View

13.

Tiemersma E, van der Werf M, Borgdorff M, Williams B, Nagelkerke N . Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review. PLoS One. 2011; 6(4):e17601. PMC: 3070694. DOI: 10.1371/journal.pone.0017601. View

14.

Kakame K, Namuhani N, Kazibwe A, Bongomin F, Baluku J, Baine S . Missed opportunities in tuberculosis investigation and associated factors at public health facilities in Uganda. BMC Health Serv Res. 2021; 21(1):359. PMC: 8052783. DOI: 10.1186/s12913-021-06368-6. View

15.

Chilembo M, Oguri S, Matsuoka Y, Ota M, Musiankuni P, Kabungo J . Pre-treatment lost to follow-up tuberculosis patients, Chongwe, Zambia, 2017: a retrospective cohort study. Public Health Action. 2020; 10(1):21-26. PMC: 7181362. DOI: 10.5588/pha.19.0059. View

16.

Uplekar M, Weil D, Lonnroth K, Jaramillo E, Lienhardt C, Dias H . WHO's new end TB strategy. Lancet. 2015; 385(9979):1799-1801. DOI: 10.1016/S0140-6736(15)60570-0. View

17.

Lemma S, Janson A, Persson L, Wickremasinghe D, Kallestal C . Improving quality and use of routine health information system data in low- and middle-income countries: A scoping review. PLoS One. 2020; 15(10):e0239683. PMC: 7544093. DOI: 10.1371/journal.pone.0239683. View

18.

Miele K, Morris S, Tepper N . Tuberculosis in Pregnancy. Obstet Gynecol. 2020; 135(6):1444-1453. PMC: 7975823. DOI: 10.1097/AOG.0000000000003890. View

19.

Kim J, Keshavjee S, Atun R . Health systems performance in managing tuberculosis: analysis of tuberculosis care cascades among high-burden and non-high-burden countries. J Glob Health. 2019; 9(1):010423. PMC: 6592589. DOI: 10.7189/jogh.09.010423. View

20.

Jedwab R, Franco M, Owen D, Ingram A, Redley B, Dobroff N . Improving the Quality of Electronic Medical Record Documentation: Development of a Compliance and Quality Program. Appl Clin Inform. 2022; 13(4):836-844. PMC: 9451950. DOI: 10.1055/s-0042-1756369. View