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MacPherson, Peter 
ORCID: https://orcid.org/0000-0002-0329-9613, Houben, Rein MGJ, Glynn, Judith R, Corbett, Elizabeth L and Kranzer, Katharina
(2014)
'Pre-treatment loss to follow-up in tuberculosis patients in low- and lower-middle-income countries and high-burden countries: a systematic review and meta-analysis'. Bulletin of the World Health Organization, Vol 92, Issue 2, pp. 126-138.
Abstract
Objective
To assess the magnitude of loss to follow-up in smear- or culture-positive tuberculosis patients before treatment initiation and outcomes among patients who were traced.
Methods
Ovid Medline and Global Health databases were searched for studies published between 1994 and January 2013 that described pre-treatment loss to follow-up in patients with smear- or culture-positive tuberculosis in routine national tuberculosis programmes (NTPs) in low- and lower-middle-income countries and in countries with a high burden of tuberculosis. Data on the proportion of patients who
did not initiate treatment after their tuberculosis diagnosis were extracted from studies meeting inclusion criteria. Where available, data on causes and outcomes, including initiation of tuberculosis treatment at another facility, were investigated. Heterogeneity and publication
bias were assessed and random-effects meta-analyses by subgroup (region) were performed.
Findings
Twenty-three eligible studies were identified, with a total of 34706 smear- or culture-positive tuberculosis patients from 14 countries (8 in Africa, 5 in Asia and 1 in the western Pacific). Most studies were retrospective and linked laboratory and treatment registers to identify pre-treatment loss to follow-up. Pre-treatment loss to follow-up varied from 4 to 38% and was common in studies from Africa (random-effects weighted proportion, WP: 18%; 95% confidence interval, CI: 13–22) and Asia (WP: 13%; 95% CI: 10–15).
Conclusion
Pre-treatment loss to follow-up, common in most settings, can hinder tuberculosis control efforts. By not counting individuals who are lost to follow-up before treatment when reporting standard programme indicators, NTPs underestimate case detection rates and mortality and overestimate cure rates.
| Item Type: | Article |
|---|---|
| Subjects: | WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) WF Respiratory System > Tuberculosis > WF 205 Epidemiology |
| Faculty: Department: | Clinical Sciences & International Health > Clinical Sciences Department |
| Digital Object Identifer (DOI): | https://doi.org/10.2471/BLT.13.124800 |
| Depositing User: | Lynn Roberts-Maloney |
| Date Deposited: | 30 Apr 2015 11:54 |
| Last Modified: | 06 Feb 2018 13:09 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/5117 |
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