Pre-diagnosis and pre-treatment loss to follow-up and associated factors among patients with presumed tuberculosis and those diagnosed in Uganda.

IF 2.7 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Rebecca Nuwematsiko, Noah Kiwanuka, Solomon T Wafula, Mary Nakafeero, Lydia Nakanjako, Henry Luzze, Stavia Turyahabwe, Juliet N Sekandi, Lynn Atuyambe, Esther Buregyeya
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引用次数: 0

Abstract

Background: Loss to follow-up (LTFU) of patients with presumed tuberculosis (TB) before completing the diagnostic process (pre-diagnosis LTFU) and before initiating treatment for those diagnosed (pre-treatment LTFU) is a challenge in the realization of the End TB Strategy. We assessed the proportion of pre-diagnosis and pre-treatment LTFU and associated factors among patients with presumed TB and those diagnosed in the selected health facilities.

Methods: This was a retrospective cohort study involving a review of routinely collected data from presumptive, laboratory and TB treatment registers from January 2019 to December 2022. The study was conducted in three general hospitals and one lower-level health center IV in Central Uganda. We defined pre-diagnosis LTFU as failure to test for TB and obtain results within 30 days from the date of being presumed and pre-treatment LTFU as failure to initiate TB treatment within 14 days from the date of diagnosis. Modified Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of factors associated with pre-diagnosis and pre-treatment LTFU.

Results: Of the 13,064 patients with presumed TB, 39.9% were aged 25 to 44 years, and 57.1% were females. Almost a third, 28.3% (3,699/13.064) experienced pre-diagnosis LTFU and 13.7% (163/1187) did not initiate treatment within 14 days from being diagnosed. Pre-diagnosis LTFU was more likely to occur among patients aged 0-14 years (adj PR 1.1, 95% CI: 1.06,1.24), females (adj.PR=1.06, 95% CI: 1.01, 1.12) and those with no record of place of residence (adj. PR=2.7, 95% CI: 2.54, 2.93). In addition, patients with no record of phone contact were more likely to be LTFU, (adj. PR=1.1, 95% CI: 1.05, 1.17). Pre-treatment LTFU was also more likely among patients with no record of place of residence (adj PR 7.1, 95% CI: 5.13,9.85) and those with no record of phone contact (adj PR 2.2, 95% CI: 1.63,2.86). Patients presumed from the HIV clinics were 40% less likely to experience pre-treatment LTFU compared to those in the outpatient departments (adj PR 0.6, 95% CI: 0.41,0.88).

Conclusion: High proportions of pre-diagnosis and pre-treatment LTFU were observed in this study. This calls for urgent interventions at these time points in the TB care cascade to be able to realise the End TB Strategy.

推定结核病患者和乌干达确诊结核病患者的诊断前和治疗前随访损失及相关因素。
背景:在完成诊断过程(诊断前LTFU)和对确诊患者开始治疗(治疗前LTFU)之前,推定结核病患者的随访缺失(LTFU)是实现终止结核病战略的一个挑战。我们评估了诊断前和治疗前LTFU的比例以及在选定的卫生机构中诊断为结核病的患者和诊断为结核病的患者的相关因素。方法:这是一项回顾性队列研究,回顾了2019年1月至2022年12月期间从推定、实验室和结核病治疗登记册中常规收集的数据。这项研究是在乌干达中部的三家综合医院和一个较低级别的保健中心进行的。我们将诊断前LTFU定义为自推定之日起30天内未能检测结核病并获得结果,将治疗前LTFU定义为自诊断之日起14天内未能开始结核病治疗。采用修正泊松回归估计与诊断前和治疗前LTFU相关因素的患病率比(pr)和95%置信区间(CIs)。结果:13064例推定结核患者中,年龄在25 ~ 44岁之间的占39.9%,女性占57.1%。几乎三分之一,28.3%(3,699/13.064)的患者在诊断前经历过LTFU, 13.7%(163/1187)的患者在诊断后14天内没有开始治疗。诊断前LTFU更容易发生在0-14岁(adj.PR= 1.1, 95% CI: 1.06,1.24)、女性(adj.PR=1.06, 95% CI: 1.01, 1.12)和无居住地记录的患者(adj.PR= 2.7, 95% CI: 2.54, 2.93)中。此外,没有电话联系记录的患者更容易发生LTFU, (jr . PR=1.1, 95% CI: 1.05, 1.17)。治疗前LTFU在没有居住地记录的患者(相对危险度7.1,95% CI: 5.13,9.85)和没有电话联系记录的患者(相对危险度2.2,95% CI: 1.63,2.86)中也更可能发生。与门诊患者相比,假定来自HIV诊所的患者治疗前LTFU的可能性要低40%(相对PR为0.6,95% CI: 0.41,0.88)。结论:本研究中观察到诊断前和治疗前LTFU的高比例。这就要求在结核病治疗级联的这些时间点采取紧急干预措施,以便能够实现终止结核病战略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Health Services Research
BMC Health Services Research 医学-卫生保健
CiteScore
4.40
自引率
7.10%
发文量
1372
审稿时长
6 months
期刊介绍: BMC Health Services Research is an open access, peer-reviewed journal that considers articles on all aspects of health services research, including delivery of care, management of health services, assessment of healthcare needs, measurement of outcomes, allocation of healthcare resources, evaluation of different health markets and health services organizations, international comparative analysis of health systems, health economics and the impact of health policies and regulations.
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