Pre-treatment lost to follow up among presumptive tuberculosis patients in a tertiary care centre, South India

Abstract

Background: At tertiary care centres, presumptive tuberculosis (TB) patients who come from far off places and are more likely to drop out during diagnosis or before treatment initiation. We aimed to describe the proportion lost during diagnosis or before treatment and also assessed the reasons for the loss to follow up.Methods: We did a hospital based descriptive study, reviewing laboratory register and referral register to assess the status of submission of second sputum and referral letter, respectively, for patients visiting a designated microscopy centre at a teaching hospital. Reasons for lost to follow up were assessed through telephonic interviews.Results: Out of a total 2025 presumptive TB patients, 315 (15.6%, 95% CI 14.0-17.2) did not provide a second sputum sample. ‘Symptoms had reduced or subsided’ (30%), ‘not aware that second sample needs to be given’ (23%) and ‘visited other hospital’ (14%) were the common reasons reported for the same. A total of 270 (13.3%) patients were sputum smear positive; of them 92 (34.1% CI 28.4-40.1) did not collect referral letter. Among those who were referred, 66% were referred within a week. Deaths, ‘busy in routine work’ and treatment at other government hospitals were the common reasons reported for not collecting referral letter.Conclusions:One out of seven patients did not submit a second sputum sample and one third of sputum smear positive TB patients did not collect the referral letter. Follow up mechanisms needs to be strengthened in the national program to reduce this pre-treatment lost to follow up.