Abstract
IntroductionWhile 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.MethodsThis 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.ResultsOf 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.ConclusionWhile 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.
Highlights
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
There is no evidence on pre-diagnostic LFU and there has not been any study from the private-for-profit health sector in Zimbabwe
6% were from private-for-profit health facilities, 40% each were from government and council health facilities and 15% from mission health facilities
Summary
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. Type of health facility was associated with pre-diagnostic LFU after adjusting for HIV status and area of residence. 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. In 2016, of the 10.4 million estimated new patients globally, only 6.3 million were detected and officially notified, leaving a gap of 4.1 million patients [1] This means that an alarming 40% of the patients were not visible to the public health system. There might be many possible reasons for this gap which include i) Difficulties in accessing health facilities ii) Pre-diagnostic loss to follow-up (TB patients reaching the health facilities, but not investigated and diagnosed) iii) Pre-treatment loss to follow-up (TB patients diagnosed, but not initiated on treatment) and iv) Nonnotification of TB patients diagnosed and treated in the publicprivate-mix facilities
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