Loss to follow-up: Understand its determinants among tuberculosis patients, in Coimbra District (2005–2017)

Q3 Medicine

Indian Journal of Tuberculosis Pub Date : 2025-04-01 DOI:10.1016/j.ijtb.2024.02.003

Ricardo Eufrásio , Maria Celeste Alcobia , Carlos Robalo Cordeiro , Henriqueta Coimbra Silva

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引用次数: 0

Abstract

Introduction

Tuberculosis patients who abscond from treatment are more likely to contribute to ongoing transmission. This growing concern has led to the development of this study in order to assess risk factors among Tuberculosis patients lost to follow up (LTFU) notified in the Coimbra District between 2005 and 2017.

Material and methods

A case-control study was designed to compare Tuberculosis patients LTFU (cases) to those successfully treated (controls). Forty-two LTFU cases were compared to 712 controls. Social and demographic data, co-morbidities, disease location, previous treatment history, drug resistance pattern and time period related to economic crisis were analyzed. In order to determine independent risk factors, numeric data was compared by one sample t-test; categorical data compared by the chi-square test or the fisher exact test, and included in a logistic regression analysis, in order to analyze their association to LTFU as a dependent variable.

Results

Bivariate analysis found that LTFU patients were more likely to be immigrants (OR:2,54; 95%CI,1,36-4,75;p < 0,01); unemployed (OR:1,99; 95%CI, 1,08-3,69;p = 0,03); civil construction workers (OR:2,53; 95%CI,1,22-5,27;p = 0,01), have a history of drug (OR:3,29; 95%CI,1,57-6,91;p < 0,01), alcohol (OR:2,16; 95%CI,1,41-3,32; p < 0,01), and tobacco abuse (OR:1,60; 95%CI,1,12-2,30; p=0,02), HIV (OR:4,15; 95%CI,2,12-8,13; p < 0,01), Hepatitis C (OR:4,51; 95%CI,1,95-10,45; p < 0,01) and Hepatitis B (OR:12,97; 95%CI,3,00–56,02; p < 0,01) virus infection. Multivariate analysis found immigrants (aOR:3,08; 95% CI, 1,20-7,93; p = 0,02) and alcohol abuse (aOR:2,81; 95% CI, 1,22-6,47; p = 0,01) to be the strongest LTFU predictor.

Conclusions

LTFU likelihood was strongly associated to addictive behaviours and immigrants. It is important that the medical teams prioritize these patients for intensive follow-up care. It is recommended stronger coordination with other support services such as mental health and substance abuse programs. Multidrug-resistant tuberculosis makes necessary to highlight all of the strategies available to its prevention and management; those, should include legislative responses towards recalcitrant patients, particularly when all other less restrictive measures fail.

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失去随访机会：了解科英布拉地区肺结核患者的决定因素（2005-2017 年）

逃避治疗的结核病患者更有可能导致持续传播。这一日益增长的担忧导致了这项研究的开展，目的是评估2005年至2017年在科英布拉地区报告的结核病患者失去随访（LTFU）的风险因素。材料与方法设计一项病例对照研究，比较LTFU肺结核患者（病例）与治疗成功肺结核患者（对照组）。42例LTFU病例与712例对照。分析与经济危机相关的社会和人口资料、合并症、疾病部位、既往治疗史、耐药模式和时间段。为了确定独立危险因素，数值数据采用单样本t检验进行比较；分类数据通过卡方检验或fisher精确检验进行比较，并纳入逻辑回归分析，以分析其与LTFU作为因变量的相关性。结果双因素分析发现，LTFU患者更有可能是移民(OR:2,54；95%可信区间,1 36,75;p & lt;0 01);失业(或:99;95%CI, 1,08-3,69;p = 0,03)；土木建筑工人(OR:2,53；95%CI,1,22-5,27;p = 0.01)，有用药史(OR:3,29；95%可信区间,1 57-6,91;p & lt;0,01)，酒精(OR:2,16；95%可信区间,1 41-3 32;p & lt;0.01)和烟草滥用(OR:1,60；95%可信区间,1、12 - 30;p=0,02), HIV (OR:4,15；95%可信区间2负13;p & lt;0,01)，丙型肝炎(OR:4,51；95%可信区间,95 - 10,45岁;p & lt;0.01)和乙型肝炎(OR: 12.97；95%可信区间3 00-56 02;p & lt;01)病毒感染。多因素分析发现移民(aOR:3,08；95% ci, 1,20-7,93；p = 0.02)和酒精滥用(aOR: 2.81；95% ci, 1,22-6,47；p = 0.01)是最强的LTFU预测因子。结论sltfu可能性与成瘾行为和移民密切相关。重要的是，医疗团队优先考虑这些患者的重症随访护理。建议加强与其他支持服务的协调，如心理健康和药物滥用项目。耐多药结核病使得有必要强调预防和管理其现有的所有战略；这些措施应包括对顽固患者的立法反应，特别是在所有其他限制性较小的措施都失败的情况下。

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来源期刊

Indian Journal of Tuberculosis Medicine-Infectious Diseases

CiteScore

2.80

自引率

0.00%

发文量

103

期刊介绍： Indian Journal of Tuberculosis (IJTB) is an international peer-reviewed journal devoted to the specialty of tuberculosis and lung diseases and is published quarterly. IJTB publishes research on clinical, epidemiological, public health and social aspects of tuberculosis. The journal accepts original research articles, viewpoints, review articles, success stories, interesting case series and case reports on patients suffering from pulmonary, extra-pulmonary tuberculosis as well as other respiratory diseases, Radiology Forum, Short Communications, Book Reviews, abstracts, letters to the editor, editorials on topics of current interest etc. The articles published in IJTB are a key source of information on research in tuberculosis. The journal is indexed in Medline