Hamufare Mugauri1, Hemant Deepak Shewade2, Riitta A Dlodlo3, Sithokozile Hove4, Edwin Sibanda5. 1. Ministry of Health and Child Care, AIDS and TB Unit, Harare, Zimbabwe. Electronic address: dumiwaboka@gmail.com. 2. The International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India. Electronic address: hemantjipmer@gmail.com. 3. The International Union Against Tuberculosis and Lung Disease (The Union), Paris, France. Electronic address: rdlodlo@theunion.org. 4. Health Services Department, City of Bulawayo, Zimbabwe. Electronic address: sthove@citybyo.co.zw. 5. Health Services Department, City of Bulawayo, Zimbabwe. Electronic address: esibanda@citybyo.co.zw.
Abstract
OBJECTIVE: To quantify and assess trends and risk factors for loss to follow-up (LTFU) and delays before treatment initiation among bacteriologically confirmed pulmonary tuberculosis (TB) patients (laboratory-diagnosed) in Bulawayo, 2012-16. DESIGN: Cohort study using secondary programme data. Presumptive TB patients' sputum samples were sent to the laboratory from the 19 primary health care clinics. Laboratory-diagnosed patients (microscopy or Xpert MTB/RIF) were tracked for treatment registration at the clinics. RESULTS: Of 2443 laboratory-diagnosed patients, the mean (standard deviation, SD) delay from sputum receipt at the laboratory to testing was 2.7(1.6) days and from testing to result dispatch was 8.8(5.8) days. A total of 508(20.8%) were LTFU which included 252(10.3%) deaths. While the number of laboratory-diagnosed patients reduced over years, there was a significant increase in pre-treatment LTFU and death. Independent predictors of pre-treatment LTFU were age above 65 years, male gender and HIV positive/unknown. In addition, delay (≥3 days) between sputum receipt and testing was significantly associated with pre-treatment death. Among registered patients (n=1935), the mean (SD) delay to initiate treatment was 29.1 (21.6) days which significantly declined over the years. Patients registered as new TB had significantly long treatment delay. CONCLUSIONS: Interventions to mitigate the risk factors for high loss to follow-up, deaths and delays before TB treatment are urgently required.
OBJECTIVE: To quantify and assess trends and risk factors for loss to follow-up (LTFU) and delays before treatment initiation among bacteriologically confirmed pulmonary tuberculosis (TB) patients (laboratory-diagnosed) in Bulawayo, 2012-16. DESIGN: Cohort study using secondary programme data. Presumptive TB patients' sputum samples were sent to the laboratory from the 19 primary health care clinics. Laboratory-diagnosed patients (microscopy or Xpert MTB/RIF) were tracked for treatment registration at the clinics. RESULTS: Of 2443 laboratory-diagnosed patients, the mean (standard deviation, SD) delay from sputum receipt at the laboratory to testing was 2.7(1.6) days and from testing to result dispatch was 8.8(5.8) days. A total of 508(20.8%) were LTFU which included 252(10.3%) deaths. While the number of laboratory-diagnosed patients reduced over years, there was a significant increase in pre-treatment LTFU and death. Independent predictors of pre-treatment LTFU were age above 65 years, male gender and HIV positive/unknown. In addition, delay (≥3 days) between sputum receipt and testing was significantly associated with pre-treatment death. Among registered patients (n=1935), the mean (SD) delay to initiate treatment was 29.1 (21.6) days which significantly declined over the years. Patients registered as new TB had significantly long treatment delay. CONCLUSIONS: Interventions to mitigate the risk factors for high loss to follow-up, deaths and delays before TB treatment are urgently required.
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