The pattern of loss to follow-up among HIV–infected clients in a tertiary health facility in North Central Nigeria

Abstract Background: In 2018, Uganda started only 65% of persons with incident tuberculosis on treatment. Pretreatment loss to follow up is an important contributor to suboptimal treatment coverage. We aimed to describe the patient and health facility-level characteristics associated with pretreatment loss to follow up among patients diagnosed with pulmonary tuberculosis at public health facilities in Uganda. Methods: At ten public health facilities, laboratory register data was used to identify patients aged 15 years who had a positive Xpert®MTB/RIF test. Initiation on TB treatment was ascertained using the clinical register. Factors associated with not being initiated on TB treatment within two weeks of diagnosis were examined using a multilevel logistic regression model accounting for clustering by health facility. Results:From January to June 2018, 510 patients (61.2% male and 31.5% HIV co-infected) were diagnosed with tuberculosis. One hundred (19.6%) were not initiated on TB treatment within two weeks of diagnosis. Not having a phone number recorded in the clinic registers (aOR 7.93, 95%CI 3.93-13.05); being HIV-infected (aOR 1.83; 95% CI: 1.09-3.26) and receiving care from a high volume health facility performing more than 12 Xpert tests per day (aOR 4.37, 95%CI 1.69-11.29) and were significantly associated with pretreatment loss to follow up. Conclusion: In public health facilities in Uganda, we found a high rate of pretreatment loss to follow up especially among TBHIV co-infected patients diagnosed at high volume health facilities. Interventions to improve the efficiency of Xpert® MTB/RIF testing, including monitoring of the TB care cascade should be developed and implemented.

Download Full-text

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

PLoS ONE ◽

10.1371/journal.pone.0241611 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241611

Author(s):

Stella Zawedde-Muyanja ◽

Joseph Musaazi ◽

Yukari C. Manabe ◽

Achilles Katamba ◽

Joaniter I. Nankabirwa ◽

...

Keyword(s):

Public Health ◽

Health Facility ◽

Health Facilities ◽

Vital Status ◽

Loss To Follow Up ◽

Public Health Facilities ◽

Tb Treatment ◽

Health Facility Level ◽

Facility Level

Introduction Tuberculosis (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. Methods At 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. Results Of 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%). Conclusion Patients 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.

Download Full-text

Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in Uganda

BMC Public Health ◽

10.1186/s12889-020-09955-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Stella Zawedde-Muyanja ◽

Achilles Katamba ◽

Adithya Cattamanchi ◽

Barbara Castelnuovo ◽

Yukari C. Manabe

Keyword(s):

Public Health ◽

Health Facility ◽

High Volume ◽

Health Facilities ◽

High Rate ◽

Loss To Follow Up ◽

Public Health Facilities ◽

Factors Associated ◽

Tb Treatment

Abstract Background In 2018, Uganda started only 65% of persons with incident tuberculosis on treatment. Pretreatment loss to follow up is an important contributor to suboptimal treatment coverage. We aimed to describe the patient and health facility-level characteristics associated with pretreatment loss to follow up among patients diagnosed with pulmonary tuberculosis at public health facilities in Uganda. Methods At ten public health facilities, laboratory register data was used to identify patients aged ≥ 15 years who had a positive Xpert®MTB/RIF test. Initiation on TB treatment was ascertained using the clinical register. Factors associated with not being initiated on TB treatment within two weeks of diagnosis were examined using a multilevel logistic regression model accounting for clustering by health facility. Results From January to June 2018, 510 patients (61.2% male and 31.5% HIV co-infected) were diagnosed with tuberculosis. One hundred (19.6%) were not initiated on TB treatment within 2 weeks of diagnosis. Not having a phone number recorded in the clinic registers (aOR 7.93, 95%CI 3.93–13.05); being HIV-infected (aOR 1.83; 95% CI: 1.09–3.26) and receiving care from a high volume health facility performing more than 12 Xpert tests per day (aOR 4.37, 95%CI 1.69–11.29) and were significantly associated with pretreatment loss to follow up. Conclusion In public health facilities in Uganda, we found a high rate of pretreatment loss to follow up especially among TBHIV co-infected patients diagnosed at high volume health facilities. Interventions to improve the efficiency of Xpert® MTB/RIF testing, including monitoring of the TB care cascade should be developed and implemented.

Download Full-text

Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in Uganda

10.21203/rs.2.17693/v2 ◽

2020 ◽

Author(s):

Stella Zawedde-Muyanja ◽

Achilles Katamba ◽

Adithya Cattamanchi ◽

Barbara Castelnuovo ◽

Yukari C Manabe

Keyword(s):

Public Health ◽

Health Facility ◽

High Volume ◽

Health Facilities ◽

Loss To Follow Up ◽

Public Health Facilities ◽

Factors Associated ◽

Tb Treatment ◽

Incident Cases

Abstract Background: In 2018, Uganda only 65% of incident cases of tuberculosis were started on treatment. Pretreatment loss to follow up is an important contributor to suboptimal treatment coverage. We aimed to describe the patient and health facility-level characteristics associated with pretreatment loss to follow up among patients diagnosed with pulmonary tuberculosis at public health facilities in Uganda. Methods: At ten public health facilities, laboratory register data was used to identify patients aged 15 years who had a positive Xpert®MTB/RIF test. Initiation on TB treatment was ascertained using the clinical register. Factors associated with not being initiated on TB treatment within two weeks of diagnosis were examined using a multilevel logistic regression model accounting for clustering by health facility. Results:From January to June 2018, 510 patients (61.2% male and 31.5% HIV co-infected) were diagnosed with tuberculosis. One hundred (19.6%) were not initiated on TB treatment within two weeks of diagnosis. Not having a phone number recorded in the clinic registers (aOR 7.93, 95%CI 3.93-13.05); being HIV-infected (aOR 1.83; 95% CI: 1.09-3.26) and receiving care from a high volume health facility performing more than 12 Xpert tests per day (aOR 4.37, 95%CI 1.69-11.29) and were significantly associated with pretreatment loss to follow up. Conclusion: In public health facilities in Uganda, we found a high rate of pretreatment loss to follow up especially among TBHIV co-infected patients diagnosed at high volume health facilities. Interventions to improve the efficiency of Xpert® MTB/RIF testing, including monitoring of the TB care cascade should be developed and implemented.

Download Full-text

Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in Uganda

10.21203/rs.2.17693/v1 ◽

2019 ◽

Author(s):

Stella Zawedde-Muyanja ◽

Achilles Katamba ◽

Adithya Cattamanchi ◽

Barbara Castelnuovo ◽

Yukari C Manabe

Keyword(s):

Public Health ◽

Health Facility ◽

High Volume ◽

Health Facilities ◽

Loss To Follow Up ◽

Public Health Facilities ◽

Factors Associated ◽

Tb Treatment ◽

Incident Cases

Abstract Background: In 2017, Uganda only 53% of incident cases of tuberculosis were started on treatment. Pretreatment loss to follow up is an important contributor to suboptimal treatment coverage. We aimed to describe the patient and health facility-level characteristics associated with pretreatment loss to follow up among patients diagnosed with pulmonary tuberculosis at public health facilities in Uganda. Methods: At ten public health facilities, laboratory register data was used to identify patients aged 15 years who had a positive Xpert®MTB/RIF test. Initiation on TB treatment was ascertained using the clinical register. Factors associated with not being initiated on TB treatment within two weeks of diagnosis were examined using a multilevel logistic regression model accounting for clustering by health facility. Results: From January to June 2018, 510 patients (61% male and 31.5% HIV co-infected) were diagnosed with tuberculosis. One hundred (19.6%) were not initiated on TB treatment within two weeks of diagnosis. Not having a phone number recorded in the clinic registers (aOR 7.93, 95%CI 3.93-13.05); being HIV-infected (aOR 1.83; 95% CI: 1.09-3.26) and receiving care from a high volume health facility performing more than 12 Xpert tests per day (aOR 4.37, 95%CI 1.69-11.29) and were significantly associated with pretreatment loss to follow up. Conclusion: In public health facilities in Uganda, we found a high rate of pretreatment loss to follow up especially among TBHIV co-infected patients diagnosed at high volume health facilities. Interventions to improve the efficiency of Xpert® MTB/RIF testing, including monitoring of the TB care cascade should be developed and implemented.

Download Full-text

Preventing Maternal to Child Transmission of HIV by Following Loss to Follow-Up From the Clinic to the Community

PsycEXTRA Dataset ◽

10.1037/e636182011-001 ◽

2010 ◽

Author(s):

Rachel Chapman

Keyword(s):

Child Transmission ◽

Loss To Follow Up

Download Full-text

KARAKTERISTIK KLINIS PASIEN YANG MENERIMA TERAPI ARV DI RSUD KABUPATEN BULELENG

Jurnal Kebidanan Malahayati ◽

10.33024/jkm.v6i2.2435 ◽

2020 ◽

Vol 6 (2) ◽

pp. 212-216

Author(s):

I Gusti Ngurah Putu Candra ◽

Dewi Aprelia Meriyani ◽

Luh Putu Desy Puspaningrat ◽

Yopita Triguno ◽

Ni Kadek Ayu Tamara Widya Sari

Keyword(s):

Loss To Follow Up ◽

Hiv Aids

ABSTRAK Latar Belakang Penyakit menular yang selalu memberikan dampak tidak hanya kesehatan tetapi social dan ekomoni adalha HIV/AIDS.Tujuan untuk mendeskripsikan kondisi klinis dan dmeografi pasien yang menerima terapi ARV.MetodePenelitian deskriptif dengan pendekatan secara kohort retrospektifmenggunakan data sekunder dari register kohort ARV dari tahun 2005-2015 (11 tahun terapi ARV). Analisis yang digunakan adalah analisis univariat menggunakan SPSS versi 17.Hasil Karakteristik klinis dan demografi pada odha yang menerima terapi ARV yaitu 45,32% dalam kondisi ambulatory, 75.42% mendapatkan regimen NNRTI jenis zidovudine, 75.82 % mendapatkan terapi regimen NRTI nevirapine, 79.66% pada kondisi stadium 3 dan 4, dengan klasifikasi umur produktif (< 40 tahun sebanyak 82.05%, sebagian besar berjenis kelamin laki-laki 62.96%, dan memiliki pengawas minum obat (PMO) sebesar 68.25%. Proporsi kematian sebesar 9.3 % (112 orang), LTFU (loss to follow up) 18.52% (223 orang), subsitusi regimen lini satu 9.88% (119 orang),rujuk keluar 1.83% (22 orang) dan yang masih dalam pengobatan sebesar 69.93% (842).Kesimpulan Pasien yang mengalami LTFU terbagi dalam beberapa kondisi yaitu LTFU dalam kondisi meninggal 3.07% (37 orang), LTFU dalam kondisi hidup 0.5% (6 orang), dan LTFU yang tidak diketahui kondisinya sebesar 14.95% (180 orang).Saran Monitoring dan evaluasi pada program pengobatan dilakukan secara berkelanjutan untuk meningkatkan konsistensi terapi yang dilakukan. Kata Kunci : Karakteristik, Terapi, HIV/AIDS

Download Full-text

Faculty Opinions recommendation of Loss to follow-up among adolescents with tuberculosis in Gaborone, Botswana.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726835778.793525979 ◽

2016 ◽

Author(s):

Anthony Harries

Keyword(s):

Loss To Follow Up

Download Full-text

Predictors of loss to follow-up in art experienced patients in Nigeria: a 13 year review (2004–2017)

AIDS Research and Therapy ◽

10.1186/s12981-019-0241-3 ◽

2019 ◽

Vol 16 (1) ◽

Author(s):

Ahmad Aliyu ◽

Babatunde Adelekan ◽

Nifarta Andrew ◽

Eunice Ekong ◽

Stephen Dapiap ◽

...

Keyword(s):

Patient Adherence ◽

Cross Sectional Study ◽

Emergency Plan ◽

Cross Sectional ◽

Loss To Follow Up ◽

Viral Loads ◽

Review Period ◽

Lost To Follow Up ◽

Differentiated Care

Abstract Background Expanded access to antiretroviral therapy (ART) leads to improved HIV/AIDS treatment outcomes in Nigeria, however, increasing rates of loss to follow-up among those on ART is threatening optimal standard achievement. Therefore, this retrospective cross-sectional study is aimed at identifying correlates and predictors of loss to follow-up in patients commencing ART in a large HIV program in Nigeria. Methods Records of all patients from 432 US CDC Presidents Emergency Plan for AIDS Relief (PEPFAR) supported facilities across 10 States and FCT who started ART from 2004 to 2017 were used for this study. Bivariate and multivariate analysis of the demographic and clinical parameters of all patients was conducted using STATA version 14 to determine correlates and predictors of loss to follow-up. Results Within the review period, 245,257 patients were ever enrolled on anti-retroviral therapy. 150,191 (61.2%) remained on treatment, 10,960 (4.5%) were transferred out to other facilities, 6926 (2.8%) died, 2139 (0.9%) self-terminated treatment and 75,041 (30.6%) had a loss to follow-up event captured. Males (OR: 1.16), Non-pregnant female (OR: 4.55), Patients on ≥ 3-monthly ARV refills (OR: 1.32), Patients with un-suppressed viral loads on ART (OR: 4.52), patients on adult 2nd line regimen (OR: 1.23) or pediatric on 1st line regimen (OR: 1.70) were significantly more likely to be lost to follow-up. Conclusion Despite increasing access to anti-retroviral therapy, loss to follow-up is still a challenge in the HIV program in Nigeria. Differentiated care approaches that will focus on males, non-pregnant females and paediatrics is encouraged. Reducing months of Anti-retroviral drug refill to less than 3 months is advocated for increased patient adherence.

Download Full-text