Determinants of the loss to follow-up of the patients with tuberculosis and the role of the social support

Abstract

Tuberculosis represents a major global health problem. The major social determinants of tuberculosis and poor disease outcome are social and economic inequalities, high level of migration, rapid urbanization.Objective — to assess the major determinants of the lost to follow-up tuberculosis patients and the role of the social support. Materials and methods. A retrospective selective, descriptive study was performed on the social, economic and epidemiological peculiarities, case-management, diagnosis, radiological aspects and microbiological characteristics of 272 lost to follow-up Moldovan patients with pulmonary tuberculosis of which 151 were interviewed.Results and discussion. It was established that the most of the patients were men, young aged, in the economical vulnerable state, without social assistance and epidemiologicaly endangered. One third of the sample avoided primary health care units, addressed directly to the hospitals and were diagnosed with severe, microbiological positive and drug-resistant forms of tuberculosis. The patients required during the interview the social and financial support, but the poor accessibility of the social organizations, associated with a high proportion of those which will change their resident place endanger the treatment completion in one third of the sample.Conclusions. After a national implementation of DOT strategy the poor treatment outcomes, increased due to standardized approach of the tuberculosis patient.The most of the patients treated after loss to follow-up were men, in early and middle adulthood, economically vulnerable, without social protection and from the epidemiological endangered groups.Patient’s avoidance of the primary health care staff, direct addressing to the hospital with severe forms of tuberculosis, microbiological positive status were the characteristics that showed the importance of a high vigilance regarding high risks for therapeutic drop-up.