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Mulaku MN, Nyagol B, Owino EJ, Ochodo E, Young T, Steingart KR. 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 2023; 16:2148355. [PMID: 36548521 PMCID: PMC9788701 DOI: 10.1080/16549716.2022.2148355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Since 2018, over 14 million people have been treated for tuberculosis (TB) globally. However, pre-treatment loss to follow-up (PTLFU) has been shown to contribute substantially to patient losses in the TB care cascade with subsequent high community transmission and mortality rates. OBJECTIVE To identify, appraise, and synthesise evidence on the perspectives of patients and healthcare workers on factors contributing to PTLFU in adults with pulmonary TB. METHODS We registered the title with PROSPERO (CRD42021253212). We searched nine relevant databases up to 24 May 2021 for qualitative studies. Two review authors independently reviewed records for eligibility and extracted data. We assessed methodological quality with the Evidence for Policy and Practice Information Centre tool and synthesised data using the Supporting the Use of Research Evidence framework. We assessed confidence in our findings using Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual). RESULTS We reviewed a total of 1239 records and included five studies, all from low- and middle-income countries. Key themes reported by patients and healthcare workers were communication challenges among healthcare workers and between healthcare workers and patients; knowledge, attitudes, and behaviours about TB and its management; accessibility and availability of facilities for TB care; and human resource and financial constraints, weakness in management and leadership in TB programmes. Patients' change of residence, long waiting times, and poor referral systems were additional factors that contributed to patients disengaging from care. We had moderate confidence in most of our findings. CONCLUSION Findings from our qualitative evidence synthesis highlight multiple factors that contribute to PTLFU. Central to addressing these factors will be the need to strengthen health systems and offer people-centred care.
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Affiliation(s)
- Mercy Namuma Mulaku
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Pharmacy, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Bruce Nyagol
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eddy Johnson Owino
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Taryn Young
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karen R Steingart
- Honorary Research Fellow, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Sengai T, Timire C, Harries AD, Tweya H, Kavenga F, Shumba G, Tavengerwei J, Ncube R, Zishiri C, Mapfurira MJ, Mandizvidza V, Sandy C. Mobile targeted screening for tuberculosis in Zimbabwe: diagnosis, linkage to care and treatment outcomes. Public Health Action 2019; 9:159-165. [PMID: 32042608 DOI: 10.5588/pha.19.0040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/01/2019] [Indexed: 11/10/2022] Open
Abstract
Setting Targeted active screening for tuberculosis (Tas4TB) using mobile trucks in the community was implemented in 15 high TB burden districts in Zimbabwe. At-risk populations were screened for TB based on symptoms and chest radiography (CXR) results. Those with any positive symptom and/or an abnormal CXR had sputum collected for investigation and diagnosis and were linked to care and treatment if found to have TB. Objective To determine 1) the proportion and characteristics of those screened and diagnosed with TB; 2) the relationship between TB symptoms, CXR and diagnostic yields; and 3) the relationship between initiation of anti-TB treatment and treatment outcomes. Design Cohort study using routinely collected data. Results A total of 39 065 persons were screened, of whom 663 (1.7%) were diagnosed with TB; 126/663 (19.0%) were bacteriologically confirmed. The highest TB diagnostic yields were in symptomatic persons with CXRs suggestive of TB (19.4%), asymptomatic persons with CXRs suggestive of TB (8.4%) and persons at high-risk of TB (3.2%). For all diagnosed TB patients, pre-treatment loss to follow-up was 18.9% and treatment success was 59.9%. Conclusion Tas4TB resulted in high diagnostic yields; however, linkage of diagnosis to care was poor. Reasons for loss to follow-up need to be better understood and rectified.
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Affiliation(s)
- T Sengai
- Family AIDS Caring Trust, Mutare, Zimbabwe
| | - C Timire
- National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe.,International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | | | - F Kavenga
- Family AIDS Caring Trust, Mutare, Zimbabwe
| | - G Shumba
- Family AIDS Caring Trust, Mutare, Zimbabwe
| | | | - R Ncube
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France
| | - C Zishiri
- International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.,The Union, Paris, France
| | - M J Mapfurira
- National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | | | - C Sandy
- National TB Control Programme, Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
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Padingani M, Kumar A, Tripathy JP, Masuka N, Khumalo S. Does pre-diagnostic loss to follow-up among presumptive TB patients differ by type of health facility? An operational research from Hwange, Zimbabwe in 2017. Pan Afr Med J 2018; 31:196. [PMID: 31086640 PMCID: PMC6488966 DOI: 10.11604/pamj.2018.31.196.15848] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 10/12/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction While there are many studies assessing the pre-treatment loss to follow-up (LFU) among tuberculosis patients in public sector, there is no evidence from private-for-profit health sector and pre-diagnostic LFU from Zimbabwe. We aimed to assess the gaps in the cascade of care of presumptive TB patients registered during January-June 2017 in different types of health facilities in Hwange district, Zimbabwe. Methods This was a cohort study involving review of routine programme data. Pre-diagnostic LFU was defined as the proportion of presumptive TB patients not tested using sputum microscopy or Xpert MTB/RIF. A log binomial regression was done to assess factors associated with pre-diagnostic LFU. Results Of 1279 presumptive TB patients, 955(75%) were tested for TB and 102(8%) were diagnosed as having TB. All TB patients were started on treatment. Pre-diagnostic LFU (overall 25%) was significantly higher among patients visiting private-for-profit health facilities (36%), local self-government run council health facilities (35%) and church-run mission health facilities (25%) compared to government health facilities (14%). Pre-diagnostic LFU was significantly higher among patients in rural areas (30%) compared to urban areas (18%). Type of health facility was associated with pre-diagnostic LFU after adjusting for HIV status and area of residence. Conclusion While pre-diagnostic LFU was high, there was no pre-treatment LFU. Pre-diagnostic LFU was especially high in private-for-profit and council health facilities and rural areas. National TB Programme should take immediate steps to improve access in rural areas and support the private-for-profit and council health facilities by improving sputum collection and transport.
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Affiliation(s)
- Munekayi Padingani
- Ministry of Health and Child Care Zimbabwe, Provincial Medical Directorate, Matebeleland North Province, Harare, Zimbabwe
| | - Ajay Kumar
- International Union Against Tuberculosis and Lung Disease, Paris, France.,International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India
| | - Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease, Paris, France.,International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India
| | - Nyasha Masuka
- Ministry of Health and Child Care Zimbabwe, Provincial Medical Directorate, Matebeleland North Province, Harare, Zimbabwe
| | - Sidingiliswe Khumalo
- Ministry of Health and Child Care Zimbabwe, Provincial Medical Directorate, Matebeleland North Province, Harare, Zimbabwe
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Khan BJ, Kumar AMV, Stewart A, Khan NM, Selvaraj K, Fatima R, Samad Z. Alarming rates of attrition among tuberculosis patients in public-private facilities in Lahore, Pakistan. Public Health Action 2017; 7:127-133. [PMID: 28695086 DOI: 10.5588/pha.17.0001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/07/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: All public-private mix (PPM) facilities caring for tuberculosis (TB) patients in Lahore city, Pakistan, under four models: PPM1 (general practitioners), PPM2 (non-governmental organisations), PPM3 (private hospitals) and PPM4 (others). Objective: To assess the pre-treatment loss to follow-up (LTFU), defined as patients documented in the laboratory registers but not in the treatment registers of any PPM facility, among sputum smear-positive TB patients diagnosed during January-March 2015, and unfavourable treatment outcomes among patients registered for treatment and associated factors. Design: This was a retrospective cohort study reviewing existing programme records. Poisson regression was used to identify factors associated with outcomes. Results: Of 2473 patients diagnosed, 1590 (64%) were lost to follow-up before treatment. This was higher among males (68%) and the elderly (79%), and lower among 'high positives' (smear grading 2+ or 3+, 53%) and in the PPM1 model (34%). Of 883 patients started on treatment, 165 (19%) had unfavourable outcomes: 8% LTFU, 5% treatment failure, 3% died and 3% not evaluated. Previously treated patients (34%) and children (44%) had the worst outcomes. Conclusion: Pre-treatment LTFU was alarmingly high and requires urgent attention, including the development and institution of mechanisms for patient tracking using information and mobile phone technology, and making TB notification mandatory in the private sector.
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Affiliation(s)
- B J Khan
- National Tuberculosis Control Program, Islamabad, Pakistan
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India.,The Union, Paris, France
| | - A Stewart
- College of Life and Environmental Science, Exeter University, Exeter, UK
| | - N M Khan
- National Tuberculosis Control Program, Islamabad, Pakistan
| | - K Selvaraj
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - R Fatima
- National Tuberculosis Control Program, Islamabad, Pakistan
| | - Z Samad
- National Tuberculosis Control Program, Islamabad, Pakistan
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Ram S, Kishore K, Batio I, Bissell K, Zachariah R, Satyanarayana S, Harries AD. Pre-treatment loss to follow-up among smear-positive pulmonary tuberculosis cases: a 10-year audit of national data from Fiji. Public Health Action 2015; 2:138-41. [PMID: 26392972 DOI: 10.5588/pha.12.0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 11/08/2012] [Indexed: 11/10/2022] Open
Abstract
SETTING All tuberculosis (TB) diagnostic and treatment centres in Fiji. OBJECTIVES To report on pre-treatment loss to follow-up rates over a 10-year period (2001-2010) and to examine if patients' age, sex and geographic origin are associated with the observed shortcomings in the health services. METHODS A retrospective review of routine programme data reconciling TB laboratory and treatment registers. RESULTS A total of 690 sputum smear-positive TB patients were diagnosed in the laboratory, of whom 579 (84%) were started on anti-tuberculosis treatment-an overall pre-treatment loss to follow-up of 111 (16%). Peak loss to follow-up rates were seen in 2003, 2004 and 2010. Pre-treatment losses were all aged ≥15 years. In the Western Division of Fiji, 33% of sputum-positive patients were declared pre-treatment loss to follow-up; this division had over five times the risk of such an adverse outcome compared to the Central Division (OR 5.2, 95%CI 3.1-8.9, P < 0.0001). CONCLUSION This study has identified an important shortcoming in programme linkage, communication and feedback between TB diagnostic and treatment services, leading to high pre-treatment loss to follow-up rates. This negatively influences TB services, and ways to rectify this situation are discussed.
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Affiliation(s)
- S Ram
- Fiji National University, Suva, Fiji
| | - K Kishore
- Fiji National University, Suva, Fiji
| | - I Batio
- Fiji National Tuberculosis Programme, Suva, Fiji
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R Zachariah
- Médecins Sans Frontières (MSF)-Operational Centre Brussels, Luxembourg
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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