Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in Uganda
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
BMC public health
Abstract
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.
Description
Keywords
Pretreatment loss to follow-up, Xpert testing, Tuberculosis
Citation
Zawedde-Muyanja, S., Katamba, A., Cattamanchi, A., Castelnuovo, B., & Manabe, Y. C. (2020). 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, 20(1), 1-8. https://doi.org/10.1186/s12889-020-09955-0