Pretreatment Loss To Follow-up Research Articles

Predictive machine learning models for anticipating loss to follow-up in tuberculosis patients throughout anti-TB treatment journey

Loss to follow-up (LTFU) in tuberculosis (TB) management increases morbidity and mortality, challenging effective control strategies. This study aims to develop and evaluate machine learning models to predict loss to follow-up in TB patients, improving treatment adherence and outcomes. Retrospective data encompassing tuberculosis patients who underwent treatment or registration at the National Center for Clinical Medical Research on Infectious Diseases from January 2017 to December 2021 were compiled. Employing machine learning techniques, namely SVM, RF, XGBoost, and logistic regression, the study aimed to prognosticate LTFU. A comprehensive cohort of 24,265 tuberculosis patients underwent scrutiny, revealing a LTFU prevalence of 12.51% (n = 3036). Education level, history of hospitalization, alcohol consumption, outpatient admission, and prior tuberculosis history emerged as precursors for pre-treatment LTFU. Employment status, outpatient admission, presence of chronic hepatitis/cirrhosis, drug adverse reactions, alternative contact availability, and health insurance coverage exerted substantial influence on treatment-phase LTFU. XGBoost consistently surpassed alternative models, boasting superior discriminative ability with an average AUC of 0.921 for pre-treatment LTFU and 0.825 for in-treatment LTFU. Our study demonstrates that the XGBoost model provides superior predictive performance in identifying LTFU risk among tuberculosis patients. The identification of key risk factors highlights the importance of targeted interventions, which could lead to significant improvements in treatment adherence and patient outcomes.

Pre-treatment Loss to Follow-up in Patients with Confirmed Pulmonary Tuberculosis in Niamey, Niger

Aims and Scope: Pre-treatment loss to follow-up (PTLFU) represents a major problem that hinders the management of tuberculosis. This paper focuses on determining the prevalence of lost to follow-up patients diagnosed with smear-positive pulmonary tuberculosis (SPPT) who are referred to other TB screening and treatment centers (TBSTC). Methods: This was a prospective, descriptive, and analytical study conducted over a six-month period between March and August 2019, in patients diagnosed with smear-positive pulmonary tuberculosis at NCFATRD and referred to Niamey and Tillaberi centers. A chi-square test was used with a significance level of P ≤ 0.05. Findings: 743 patients were diagnosed with SPPT, and 346 were referred to the TBSTC located in Niamey and Tillaberi cities. The prevalence of loss to follow-up before treatment in both Niamey and Tillaberi cities was 14.45% (50/343). Males represented 82% (41) of the cases with a sex ratio of 4.55. The mean age of the patients was 41.04 years. Patients not attending school, as well as those with primary school education, represented the majority of cases, accounting for 30% each. The majority of PTLFU (95.66%) were new cases of TB. Nearly half (42%) of PTLFU had traveled a distance of 6 to 15 km to receive TB screening. During the phone call follow up, only 12 patients (24%) were reached, of whom 7 (14%) were deceased. Conclusion: The prevalence of PTLFU remains high. Therefore, reinforcing the research of lost to follow-up patients is necessary to enhance tuberculosis control and management.

Pre-treatment loss to follow-up in adults with pulmonary TB in Kenya

<sec><title>SETTING</title>County referral hospital in western Kenya.</sec><sec><title>OBJECTIVES</title>To ascertain the proportion of pre-treatment loss to follow-up (PTLFU) and associated patient factors in adults with pulmonary TB (PTB) in western Kenya.</sec><sec><title>DESIGN</title>A retrospective data review of laboratory and treatment registers for adults with bacteriologically confirmed PTB between January 2018 to December 2021. We defined PTLFU as failure to initiate treatment within 14 days of diagnosis. We used multivariable logistic regression modelling to identify patient factors associated with PTLFU.</sec><sec><title>RESULTS</title>Of 476 patients with PTB, 67.2% were male; the mean age was 36.1 years; 37.0% were HIV-positive; 5.7% had a history of anti-TB treatment; 40.6% were not traceable in the treatment register; 202 (42.4%, 95% CI 38.1–46.9) experienced PTLFU. Age ≥55 years (aOR 2.6, 95% CI 1.0–6.7) and providing only an address (aOR 34.2, 95% CI 18.7–62.5) or only a telephone contact number (aOR 22.3, 95% CI 3.5–141.1) were associated with PTLFU. Sex, HIV status, history of anti-TB treatment and place of residence were not associated with PTLFU.</sec><sec><title>CONCLUSION</title>PTLFU contributes markedly to TB patient losses in western Kenya. Strengthening systems for documenting patient information and actively monitoring PTLFU are crucial for attrition reduction.</sec>

Health worker views on pre-treatment loss to follow-up in adults with pulmonary TB in Western Kenya.

County referral hospital in Western Kenya. To explore factors contributing to pre-treatment loss to follow-up (PTLFU) in adults with pulmonary TB and propose solutions to address PTLFU from healthcare worker (HCW) perspectives. This was an exploratory qualitative study using thematic analysis. We conducted 19 key informant interviews with HCWs representing laboratory, clinical care, management and the community. Participant age ranged from 26 to 62 years; 14 (74%) were females; and most (74%) had worked in TB care for ⩽5 years. They reported that patients experienced stigma and had misconceptions about TB that contributed to PTLFU. HCWs were hesitant to work in the TB clinic, which contributed to suboptimal patient care, leading to PTLFU. Unclear linkage between laboratory and clinician, and limited financial resources to track patients were among the healthcare system factors that led to PTLFU. HCWs suggested having proper patient preparation, assigning resources to track patients and holding regular interdisciplinary meetings as practical solutions to address PTLFU. HCWs reported multiple factors that may influence PTLFU and recommended various solutions to address these. Knowledge of TB management, patient preparation, resources to track patients and multidisciplinary meetings will be central to addressing PTLFU.

Pre-Treatment Loss to Follow Up of Tuberculosis Patients; Prevalence and Reasons for It in Central Karnataka, India

Background: Pre-treatment loss to follow up (PTLFU) is defined as diagnosed TB patients not initiated on treatment within 14 days of TB diagnosis. Bringing these PTLFU cases into care can reduce the disease transmission and mortality. The present study was undertaken with main objectives to study the prevalence of PTLFU in TB patients and to know the reasons for PTLFU. Methodology: A cross-sectional study was conducted among 38 PTLFU TB patients of Davangere district, Karnataka from January to March 2019. Study participants were personally interviewed using pre-tested, semi-structured questionnaire. Data was analyzed using SPSS software. Results: The prevalence of PTLFU in TB patients is 3.6%. The reasons for PTLFU were, out of the 38 study subjects, 17 (47%) of them were initiated on treatment in private sector but reported as PTLFU. 7 (18%) died in hospital before treatment initiation. 7 (18%) did not start the treatment because of fear of side effects following anti tuberculosis treatment, whereas 2 (6%) of them did not take treatment by seeing the side effects in others and 5 (13%) had alcoholic withdrawal effects. Conclusions: Improvement in recording of contact details, biometric registration of all presumptive TB cases and pre-treatment counselling of all diagnosed TB patients may reduce PTLFU.

Estimating the effect of pretreatment loss to follow up on TB associated mortality at public health facilities in Uganda.

IntroductionTuberculosis (TB) mortality estimates derived only from cohorts of patients initiated on TB treatment do not consider outcomes of patients with pretreatment loss to follow-up (LFU). We aimed to assess the effect of pretreatment LFU on TB-associated mortality in the six months following TB diagnosis at public health facilities in Uganda.MethodsAt ten public health facilities, we retrospectively reviewed treatment data for all patients with a positive Xpert®MTB/RIF test result from January to June 2018. Pretreatment LFU was defined as not initiating TB treatment within two weeks of a positive test. We traced patients with pretreatment LFU to ascertain their vital status. We performed Kaplan Meier survival analysis to compare the cumulative incidence of mortality, six months after diagnosis among patients who did and did not experience pretreatment LFU. We also determined the health facility level estimates of TB associated mortality before and after incorporating deaths prior to treatment initiation among patients who experienced pretreatment LFU.ResultsOf 510 patients with positive test, 100 (19.6%) experienced pretreatment LFU. Of these, we ascertained the vital status of 49 patients. In the six months following TB diagnosis, mortality was higher among patients who experienced pretreatment LFU 48.1/1000py vs 22.9/1000py. Hazard ratio [HR] 3.18, 95% confidence interval [CI] (1.61–6.30). After incorporating deaths prior to treatment initation among patients who experienced pretreatment LFU, health facility level estimates of TB associated mortality increased from 8.4% (95% CI 6.1%-11.6%) to 10.2% (95% CI 7.7%-13.4%).ConclusionPatients with confirmed TB who experience pretreatment LFU have high mortality within the first six months. Efforts should be made to prioritise linkage to treatment for this group of patients. Deaths that occur prior to treatment initation should be included when reporting TB mortality in order to more accurately reflect the health impact of TB.

Identifying and Addressing Factors Contributing to Pretreatment Loss to Follow-Up of Tuberculosis Patients Referred for Treatment from Medical Colleges in Pondicherry: An Implementation Research.

Background:In India, there is no feedback regarding 34% of tuberculosis (TB) patients diagnosed and referred from medical colleges for treatment to peripheral health institutions (PHIs).Objectives:The aim of this study is to measure the effectiveness of the new intervention package, developed based on qualitative study in reducing pretreatment loss to follow-up (PTLFU) of all TB patients diagnosed and referred for treatment from medical colleges to PHIs.Materials and Methods:An intervention was developed based on the findings of in depth-interviews conducted among different stakeholders such as TB patients who did/did not report, service providers working in four medical colleges in Pondicherry. Intervention consisting of phone calls, home visits, etc., was implemented for a period of 6 months. The baseline and endline proportion of TB patients for whom feedback received was determined from the available records (Revised National TB Control Program State Task Force Quarterly reports).Results:Patient's ignorance, lack of faith in healthcare system, side effects and social stigma, unpleasant experience in hospitals, poor accessibility to directly observed treatment, short-course centers, drugs shortage, poor coordination between program and hospital staff were the risk factors for PTLFU. At baseline, the proportions of feedback received about TB patients referred for treatment from medical colleges to PHIs was 46%. After the initiation of interventions, it increased to 61% and 66% in the first and second quarters of 2017, respectively.Conclusion:Risk factors for PTLFU were multi-factorial related to both patient and health system. Simple, feasible interventions such as phone calls and home visits to TB patients were effective in reducing PTLFU.

Where, when, and how many tuberculosis patients are lost from presumption until treatment initiation? A step by step assessment in a rural district in Zimbabwe

ObjectivesTo describe the pre-diagnosis and pre-treatment loss to follow-up (LTFU) in the tuberculosis (TB) care cascade in Guruve (2015–16), a rural district in Zimbabwe. DesignGuruve has 19 rural health centres (RHCs) and one district hospital. In this cohort study, persons ≥15 years of age with presumptive pulmonary TB were tracked from the facility presumptive TB registers to the laboratory registers; if laboratory diagnosed, they were tracked to the district TB register (contains details of all TB patients registered for treatment). Each patient was tracked for 90days after registration as presumptive TB and for 90days after laboratory diagnosis. Environmental health technicians transported sputum specimens from the health facilities to the laboratories (n=3). ResultsOf 2974 persons with presumptive TB, pre-diagnosis LTFU occurred in 575 (19%, 95% confidence interval 18–21%). Associated factors included registration at a RHC, at a facility more than 2km from the laboratory, and absence of an environmental health technician. Of 162 laboratory diagnosed pulmonary TB patients, pre-treatment LTFU occurred in 19 (12%, 95% confidence interval 8–18%). ConclusionsThe presumptive TB register was helpful to assess the pre-diagnosis gaps beginning from presumption. Pre-diagnosis LTFU can be reduced by placement of an environmental health technician at all facilities.

Bacteriologically confirmed pulmonary tuberculosis patients: Loss to follow-up, death and delay before treatment initiation in Bulawayo, Zimbabwe from 2012–2016

ObjectiveTo 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. DesignCohort 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. ResultsOf 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. ConclusionsInterventions to mitigate the risk factors for high loss to follow-up, deaths and delays before TB treatment are urgently required.

Pre-treatment loss to follow-up of pulmonary tuberculosis patients in two regions of Cameroon.

Thirty-nine tuberculosis diagnosis and treatment units (DTUs) in the North-West and South-West Regions of Cameroon. To determine the proportion of pre-treatment loss to follow-up (PLTFU) of bacteriologically confirmed pulmonary tuberculosis (PTB) patients and its risk factors. A retrospective cohort study was conducted to retrieve information from the TB laboratory and treatment registers for all bacteriologically confirmed PTB patients diagnosed in the 39 DTUs during the last 6 months of 2015. PLTFU was defined as failure to initiate treatment within 7 days of diagnosis. Among 1174 bacteriologically confirmed PTB cases, the proportion of PLTFU was 16.7% (95%CI 14.7-18.9). In the multivariable logistic regression model, travelling >30 km to the DTU was a risk factor for PLTFU (adjusted odds ratio [aOR] 2.31, 95%CI 1.63-3.27) compared with travelling 30 km. Travelling for >30 min to the DTU (aOR 2.19, 95%CI 1.56-3.09) and an urban location of DTU (aOR 2.51, 95%CI 1.51-4.17) were also significant risk factors for PLTFU. PLTFU among TB patients remains a significant issue despite the availability of free anti-tuberculosis treatment in Cameroon. Diagnosed patients should be promptly and carefully linked to a treatment unit for treatment initiation.

Does pre-diagnostic loss to follow-up among presumptive TB patients differ by type of health facility? An operational research from Hwange, Zimbabwe in 2017.

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.

Alarming rates of attrition among tuberculosis patients in public-private facilities in Lahore, Pakistan.

Setting: All public-private mix (PPM) facilities caring for tuberculosis (TB) patients in Lahore city, Pakistan, under four models: PPM1 (general practitioners), PPM2 (non-governmental organisations), PPM3 (private hospitals) and PPM4 (others). Objective: To assess the pre-treatment loss to follow-up (LTFU), defined as patients documented in the laboratory registers but not in the treatment registers of any PPM facility, among sputum smear-positive TB patients diagnosed during January-March 2015, and unfavourable treatment outcomes among patients registered for treatment and associated factors. Design: This was a retrospective cohort study reviewing existing programme records. Poisson regression was used to identify factors associated with outcomes. Results: Of 2473 patients diagnosed, 1590 (64%) were lost to follow-up before treatment. This was higher among males (68%) and the elderly (79%), and lower among 'high positives' (smear grading 2+ or 3+, 53%) and in the PPM1 model (34%). Of 883 patients started on treatment, 165 (19%) had unfavourable outcomes: 8% LTFU, 5% treatment failure, 3% died and 3% not evaluated. Previously treated patients (34%) and children (44%) had the worst outcomes. Conclusion: Pre-treatment LTFU was alarmingly high and requires urgent attention, including the development and institution of mechanisms for patient tracking using information and mobile phone technology, and making TB notification mandatory in the private sector.

Pre-treatment loss to follow-up among smear-positive TB patients in tertiary hospitals, Quetta, Pakistan.

Setting: Three public sector tertiary care hospitals in Quetta, Balochistan, Pakistan, with anecdotal evidence of gaps between the diagnosis and treatment of patients with tuberculosis (TB). Objectives: To assess the proportion of pre-treatment loss to follow-up (LTFU), defined as no documented evidence of treatment initiation or referral in TB registers, among smear-positive pulmonary TB patients diagnosed in 2015, and the associated sociodemographic factors. Design: A retrospective cohort study involving the review of laboratory and TB registers. Results: Of 1110 smear-positive TB patients diagnosed (58% female, median age 40 years, 5% from outside the province or the country), 235 (21.2%) were lost to follow-up before starting treatment. Pre-treatment LTFU was higher among males; in patients residing far away, in rural areas, outside the province or the country; and in those without a mobile phone number. Conclusion: About one fifth of the smear-positive TB patients were lost to follow-up before starting treatment. Strengthening the referral and feedback mechanisms and using information technology to improve the tracing of patients is urgently required. Further qualitative research is needed to understand the reasons for pre-treatment LTFU from the patient's perspective.

Indicators to Ensure Treatment Initiation of All Diagnosed Sputum Positive Pulmonary Tuberculosis Patients under Tuberculosis Control Programme in India.

Background:Pretreatment loss to follow-up (PTLFU) is used as performance indicator of Revised National Tuberculosis Control Programme (RNTCP) of India.Objective:To document the PTLFU, identify additional indicators and examine documentation of all the diagnosed sputum positive pulmonary tuberculosis (PTB) patients under RNTCP.Methodology:Tuberculosis (TB) laboratory, referral for treatment registers, and referral forms were perused for information on sputum positive PTB patients diagnosed from January to June 2014, in 3 TB Units in Chennai.Results:PTLFU was 24% (572 out of 2361). However, in pursuance with the principle of ensuring that all diagnosed patients must be started on treatment following referral, it was inflated to 44% (1046 out of 2361).Conclusion:The existing PTLFU indicator does not reflect the proportion of treatment initiation of all diagnosed smear-positive PTB patients. We propose additional indicators for monitoring referral and treatment initiation of all diagnosed sputum positive PTB patients.