Lost to follow-up and associated factors among patients with drug resistant tuberculosis in Ethiopia: A systematic review and meta-analysis.

Assefa Andargie,Segenet Zewdie,Asressie Molla,Fentaw Tadese,Claudia Marotta

doi:10.1371/journal.pone.0248687

Abstract

One third of global antmicrobial resistance deaths are attributed to drug resistant tuberculosis. Lost to follow-up is one of the causes of the development of acquired drug resistant tuberculosis. There is a gap in nationally representative reliable information on lost to follow-up among patients with drug-resistant tuberculosis in Ethiopia. To estimate the pooled prevalence and associated factors of lost to follow-up among patients with drug resistant tuberculosis in Ethiopia. Observational studies searched from PubMed, HINARI and CINAHL were screened for eligibility. After assessing the quality of studies, data were extracted using a checklist. Heterogeneity was assessed using forest plot, Q and I2. The random effects meta-analysis model was employed to pull the prevalence of lost to follow-up. Sub-group analysis and meta regression were performed to identify the sources of heterogeneity. Publication bias was assessed using funnel plots with Egger's and Begg's tests. Sensitivity analysis was performed to assess the influence of individual studies on the overall estimate. The odds ratios were used to measure associations. The review was performed among 11 studies of which 9 were cohort studies. The sample sizes ranged from 90 to 612 and comprised a total of 3,510 participants. The pooled prevalence of lost to follow-up was 8.66% (95% CI, 5.01-13.14) with a high heterogeneity (I2 = 93.49%, p<0.001). Pulmonary multi-drug resistant tuberculosis patients were 50% less likely to loss from follow-up compared to extra pulmonary tuberculosis patients. There was a high prevalence of lost to follow-up among multi-drug resistant tuberculosis patients in Ethiopia. Anatomical site of tuberculosis was a significant factor affecting lost to follow-up. Strengthening the health care system and patient education should be given a due emphasis. CRD42020153326; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=153326.

Highlights

Drug resistant tuberculosis (DR-TB) is an emerging global public health threat
Pulmonary multi-drug resistant tuberculosis patients were 50% less likely to loss from follow-up compared to extra pulmonary tuberculosis patients
This prevalence of Lost to follow up (LTFU) implies that a significant number of DR-TB patients was discontinued from their recommended treatment before they reached to the recommended duration

Summary

Introduction

Drug resistant tuberculosis (DR-TB) is an emerging global public health threat. In 2018, 484,000 people developed TB that was resistant to rifampicin (RR-TB), and of these, 78% had multidrug-resistant TB (MDR-TB). About 187,000 cases of MDR/RR-TB were detected and notified in this year. Among cases of MDR-TB in the same year, 6.2% were estimated to have extensively drug-resistant TB (XDR-TB) [1]. In the year 2017, one-third of global antimicrobial resistance deaths are attributed to MDR-TB [2]. One third of global antmicrobial resistance deaths are attributed to drug resistant tuberculosis. Lost to follow-up is one of the causes of the development of acquired drug resistant tuberculosis.

Methods

Discussion

Conclusion