C C Kasapo1, R Chimzizi1, S C Simwanza1, J Mzyece1, E Chizema2, A Mariandyshev3, H-Y Lee4, A D Harries5, N Kapata6. 1. National TB and Leprosy Control Programme, Lusaka, Zambia. 2. Department of Public Health and Research, Ministry of Health, Lusaka, Zambia. 3. Northern State Medical University, Archangelsk, The Russian Federation. 4. Pingtung Christian Hospital, Pingtung, Taiwan, Luke International, Mzuzu, Malawi. 5. International Union Against Tuberculosis and Lung Disease, Paris, France; London School of Hygiene & Tropical Medicine, London, UK. 6. National TB and Leprosy Control Programme, Lusaka, Zambia; Department of Public Health and Research, Ministry of Health, Lusaka, Zambia.
Abstract
SETTING: University Teaching Hospital, Lusaka, and Ndola Central Hospital, Ndola, Zambia, which implemented active tracing of multidrug-resistant tuberculosis (MDR-TB) patients reported as lost to follow-up (LTFU). OBJECTIVE: To determine 1) the number of patients treated for MDR-TB between 2011 and 2014; 2) the number, proportion, month when LTFU and characteristics of patients registered as LTFU; and 3) final outcomes observed following active patient tracing. DESIGN: Retrospective cohort study. RESULTS: Of 184 patients treated for confirmed MDR-TB, 76 (41%) were reported as LTFU. From 2011 to 2014, the proportions reported each year as LTFU were respectively 21%, 47%, 51% and 39%. Of patients who were LTFU, 43 (57%) had stopped attending the clinic during the intensive phase. These patients were predominantly male, aged 15-44 years, had pulmonary disease and had failed previous treatment. Of 57 (75%) patients with known human immunodeficiency virus (HIV) status, 42 (74%) were HIV-positive, 57% of whom were on antiretroviral treatment. After active patient tracing, 29 (38%) patients could not be found and the observed outcome remained LTFU. Of the remaining 47 patients, 29 (62%) were alive and had completed or were still on treatment, 14 (30%) were alive but had stopped treatment and 4 (8%) had died. CONCLUSION: Zambia has been underreporting its favourable outcomes for MDR-TB treatment and should continue with active tracing of LTFU patients.
SETTING: University Teaching Hospital, Lusaka, and Ndola Central Hospital, Ndola, Zambia, which implemented active tracing of multidrug-resistant tuberculosis (MDR-TB) patients reported as lost to follow-up (LTFU). OBJECTIVE: To determine 1) the number of patients treated for MDR-TB between 2011 and 2014; 2) the number, proportion, month when LTFU and characteristics of patients registered as LTFU; and 3) final outcomes observed following active patient tracing. DESIGN: Retrospective cohort study. RESULTS: Of 184 patients treated for confirmed MDR-TB, 76 (41%) were reported as LTFU. From 2011 to 2014, the proportions reported each year as LTFU were respectively 21%, 47%, 51% and 39%. Of patients who were LTFU, 43 (57%) had stopped attending the clinic during the intensive phase. These patients were predominantly male, aged 15-44 years, had pulmonary disease and had failed previous treatment. Of 57 (75%) patients with known human immunodeficiency virus (HIV) status, 42 (74%) were HIV-positive, 57% of whom were on antiretroviral treatment. After active patient tracing, 29 (38%) patients could not be found and the observed outcome remained LTFU. Of the remaining 47 patients, 29 (62%) were alive and had completed or were still on treatment, 14 (30%) were alive but had stopped treatment and 4 (8%) had died. CONCLUSION: Zambia has been underreporting its favourable outcomes for MDR-TB treatment and should continue with active tracing of LTFU patients.
Authors: Anthony D Harries; Ajay M V Kumar; Srinath Satyanarayana; Pruthu Thekkur; Yan Lin; Riitta A Dlodlo; Rony Zachariah Journal: Trop Med Infect Dis Date: 2019-03-15
Authors: T Sengai; C Timire; A D Harries; H Tweya; F Kavenga; G Shumba; J Tavengerwei; R Ncube; C Zishiri; M J Mapfurira; V Mandizvidza; C Sandy Journal: Public Health Action Date: 2019-12-21