Department of Social and Behavioral Research, National Institute for Research in Tuberculosis, No. 1, Mayor Sathiyamoorthy Road, Chetpet, Chennai, 600031, India.
Nutrition Infection Unit, Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave., Boston, 02111, USA.
BMC Infect Dis. 2018 Mar 27;18(1):142. doi: 10.1186/s12879-018-3039-3.
Pretreatment loss to follow-up (PTLFU) is a barrier to tuberculosis (TB) control in India's Revised National TB Control Programme (RNTCP). PTLFU studies have not been conducted in India's mega-cities, where patient mobility may complicate linkage to care.
We collected data from patient registries for May 2015 from 22 RNTCP designated microscopy centers (DMCs) in Chennai and audited addresses and phone numbers for patients evaluated for suspected TB to understand how missing contact information may contribute to PTLFU. From November 2015 to June 2016, we audited one month of records from each of these 22 DMCs and tracked newly diagnosed smear-positive patients using RNTCP records, phone calls, and home visits. We defined PTLFU cases as including: (1) patients who did not start TB therapy within 14 days and (2) patients who started TB therapy but were lost to follow-up or died before official RNTCP registration. We used multivariate logistic regression to identify factors associated with PTLFU.
In the audit of May 2015 DMC registries, out of 3696 patients evaluated for TB, 1273 (34.4%) had addresses and phone numbers that were illegible or missing. Out of 344 smear-positive patients tracked from November 2015 to June 2016, 40 (11.6%) did not start TB therapy within 14 days and 36 (10.5%) started therapy but were lost to follow-up or died before official RNTCP registration, for an overall PTLFU rate of 22.1% (95%CI: 17.8%-26.4%). Of all PTLFU patients, 55 (72.4%) were lost to follow-up and 21 (27.6%) died before starting treatment or before RNTCP registration. In the regression analysis, age > 50 years (OR 2.9, 95%CI 1.4-6.5), history of prior TB (OR 3.9, 95%CI 2.2-7.1), evaluation at a high patient volume DMC (OR 3.2, 95% CI 1.7-6.3), and absence of legible patient contact information (OR 4.5, 95%CI 1.3-15.1) were significantly associated with PTLFU.
In an Indian mega-city, we found a high PTLFU rate, especially in patients with a prior TB history, who are at greater risk for having drug-resistance. Enhancing quality of care and health system transparency is critical for improving linkage of newly diagnosed patients to TB care in urban India.
在印度修订国家结核病控制规划（RNTCP）中，治疗前失访（PTLFU）是结核病（TB）控制的一个障碍。印度的大城市尚未进行过 PTLFU 研究，而这些城市的患者流动性可能会使患者与护理的联系变得复杂。
我们从 2015 年 5 月来自钦奈 22 个 RNTCP 指定显微镜检查中心（DMC）的患者登记处收集数据，并审核疑似结核病患者的地址和电话号码，以了解缺失的联系方式如何导致 PTLFU。从 2015 年 11 月至 2016 年 6 月，我们审核了这 22 个 DMC 中每个 DMC 的一个月的记录，并使用 RNTCP 记录、电话和家访来跟踪新诊断的涂片阳性患者。我们将 PTLFU 病例定义为：（1）未在 14 天内开始结核病治疗的患者；（2）开始结核病治疗但在官方 RNTCP 登记之前失访或死亡的患者。我们使用多变量逻辑回归来确定与 PTLFU 相关的因素。
在 2015 年 5 月 DMC 登记处的审核中，在 3696 名评估结核病的患者中，有 1273 名（34.4%）的地址和电话号码难以辨认或缺失。在 2015 年 11 月至 2016 年 6 月期间，我们跟踪了 344 名涂片阳性患者，其中有 40 名（11.6%）未在 14 天内开始结核病治疗，有 36 名（10.5%）开始治疗但在官方 RNTCP 登记之前失访或死亡，总的 PTLFU 发生率为 22.1%（95%CI：17.8%-26.4%）。在所有 PTLFU 患者中，有 55 名（72.4%）失访，21 名（27.6%）在开始治疗或在 RNTCP 登记之前死亡。在回归分析中，年龄＞50 岁（OR 2.9，95%CI 1.4-6.5）、既往结核病史（OR 3.9，95%CI 2.2-7.1）、在高患者量 DMC 就诊（OR 3.2，95%CI 1.7-6.3）和缺乏清晰的患者联系信息（OR 4.5，95%CI 1.3-15.1）与 PTLFU 显著相关。
在印度的一个大城市中，我们发现 PTLFU 率很高，特别是在有既往结核病史的患者中，这些患者发生耐药的风险更高。加强医疗质量和卫生系统透明度对于改善印度城市新诊断患者与结核病护理的联系至关重要。
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