Estimating the effect of pretreatment loss to follow up on TB associated mortality at public health facilities in Uganda
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
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.
Description
Keywords
Pretreatment loss, TB associated mortality, Public health facilities
Citation
Zawedde-Muyanja S, Musaazi J, Manabe YC, Katamba A, Nankabirwa JI, Castelnuovo B, et al. (2020) Estimating the effect of pretreatment loss to follow up on TB associated mortality at public health facilities in Uganda. PLoS ONE 15 (11): e0241611. https://doi.org/10.1371/journal. pone.0241611