Shaweno Tamrat, Getnet Masrie, Fikru Chaltu
Department of Epidemiology, Faculty of Public Health, Jimma University Institute of Health, Jimma, Ethiopia.
Trop Med Health. 2020 Feb 18;48:9. doi: 10.1186/s41182-020-00198-8. eCollection 2020.
Patients' loss to follow-up (LTFU) from tuberculosis treatment and care is a growing worry in Ethiopia. But, available information is inadequate in assessing the time to tuberculosis patient loss to follow-up difference between health centers and a general hospital in Ethiopia. We aimed to assess time to LTFU difference between health centers and a general hospital in rural Ethiopia.
We conducted a retrospective cohort study from September 2008 to August 2015 and collected data from September 1 to October 02, 2016. A total of 1341 TB patients with known treatment outcomes were included into the study. Log rank test was used to compare the difference in time to TB patient loss to follow-up between health centers and a general hospital, whereas Cox proportional hazard model was used to assess factors associated with time to loss to follow-up in both settings.
We reviewed a total of 1341 patient records, and the overall follow-up time was 3074.7 and 3974 person months of observation (PMOs) for TB patients followed at health centers and a general hospital, respectively. The incidence of loss to follow-up rate was 27.3 per 1000 PMOs and 9.6 per 1000 PMOs, at health centers and a general hospital, respectively. From the overall loss to follow-ups that occurred, 55 (65.5%) and 33 (86.8%) of LTFUs occurred during the intensive phase and grew to 78 (92.9%) and 38 (100%) at health center and a general hospital, respectively, at the end of 6-month observation period. Older age (AOR = 1.7, 95%CI, 1.2-2.5, < 0.001), being a rural resident (AHR = 2.7, 95%CI, 1.6-4.6), HIV reactive (AHR = 2.2, 95%CI, 1.5-3.2), following treatment and care in health center (AHR = 3.38, 95%CI, 2.06-5.53), and living at more than 10 km away from the health facility (AHR = 3.4, 95%CI, 2.1-5.7) were predictors for time to loss to follow-up among TB patients on treatment and care.
Time to TB patient loss to follow-up between health centers and a general hospital was significant. Loss to follow-up was high in patients with older age, rural residence, sero positive for HIV, living further from the health facilities, and following treatment and care at health centers. Strengthening the DOTs program with special emphasis on health centers is highly recommended.
在埃塞俄比亚，结核病治疗与照护中患者失访情况日益令人担忧。然而，现有信息不足以评估埃塞俄比亚各健康中心与一家综合医院结核病患者失访时间的差异。我们旨在评估埃塞俄比亚农村地区健康中心与一家综合医院的结核病患者失访时间差异。
我们于2008年9月至2015年8月开展了一项回顾性队列研究，并于2016年9月1日至10月2日收集数据。共有1341例已知治疗结果的结核病患者纳入本研究。采用对数秩检验比较健康中心与一家综合医院结核病患者失访时间的差异，而Cox比例风险模型用于评估两种环境下与失访时间相关的因素。
我们共查阅了1341份患者记录，健康中心和综合医院结核病患者的总体随访时间分别为3074.7和3974人月观察期（PMOs）。健康中心和综合医院的失访率分别为每1000 PMOs 27.3例和每1000 PMOs 9.6例。在发生的总体失访中，分别有55例（65.5%）和33例（86.8%）失访发生在强化期，在6个月观察期末，健康中心和综合医院分别增至78例（92.9%）和38例（100%）。年龄较大（调整后风险比[AOR]=1.7，95%置信区间[CI]，1.2 - 2.5，P<0.001）、为农村居民（调整后风险比[AHR]=2.7，95%CI，1.6 - 4.6）、HIV反应阳性（AHR=2.2，95%CI，1.5 - 3.2）、在健康中心接受治疗与照护（AHR=3.38，95%CI，2.06 - 5.53）以及居住在距离医疗机构10公里以上（AHR=3.4，95%CI，2.1 - 5.7）是接受治疗与照护的结核病患者失访时间的预测因素。
健康中心与一家综合医院的结核病患者失访时间存在显著差异。年龄较大、农村居民、HIV血清学阳性、居住距离医疗机构较远以及在健康中心接受治疗与照护的患者失访率较高。强烈建议加强直接观察治疗短程化疗（DOTs）项目，尤其要重点关注健康中心。
