Berita Kesehatan
Analysis of loss to follow up in 4,099 multidrug-resistant pulmonary tuberculosis patients
Senin, 13 Mei 2019 17:07:41

Ian F. WalkerOumin ShiJoseph HicksHelen ElseyXiaolin WeiDick MenziesZhiyi LanDennis FalzonGiovanni Battista MiglioriCarlos Pérez-GuzmánMario H. VargasLourdes García-GarcíaJosé Sifuentes OsornioAlfredo Ponce-De-LeónMartie van der WaltJames N. Newell

European Respiratory Journal 2019; DOI: 10.1183/13993003.00353-2018

Abstract

Loss-to-follow-up (LFU) of two or more consecutive months contributes to the poor levels of treatment success in multidrug-resistant tuberculosis (MDR-TB) reported by TB programmes. We explored the timing of when LFU occurs by month of MDR-TB treatment and identified patient-level risk factors associated with LFU.

We analysed a dataset of individual MDR-TB patient data (4099 patients from 22 countries). We used Kaplan-Meier survival curves to plot time to LFU and a Cox proportional hazards model to explore the association of potential risk factors with LFU.

One-sixth (n=702) of patients were recorded as LFU. Median time to LFU was 7 months (IQR=3–11). The majority of LFU occurred in the initial phase of treatment (75% in the first 11 months). Major risk factors associated with LFU were: age 36–50 years (Hazard Ratio (HR) 1.3; 95% CI 1.0, 1.6, p=0.04) compared with age 0–25 yrs, being HIV+(HR 1.8; 95% CI 1.2, 2.7, p<0.01) compared with HIV-, on an individualised treatment regimen (HR 0.7; 95% CI 0.6, 1.0, p=0.03) compared with standardised regimen and a recorded serious adverse event (HR 0.5; 95% CI 0.4, 0.6, p<0.01) compared with no serious adverse event.

Both patient- and regimen-related factors were associated with LFU which may guide interventions to improve treatment adherence, particularly in the first 11 months.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Mr. Walker reports grants from DFID, UK Government, during the conduct of the study.

Conflict of interest: Dr. Shi has nothing to disclose.

Conflict of interest: Dr. Hicks has nothing to disclose.

Conflict of interest: Dr. Elsey has nothing to disclose.

Conflict of interest: Dr. Wei has nothing to disclose.

Conflict of interest: Dr. Menzies has nothing to disclose.

Conflict of interest: Dr. Lan has nothing to disclose.

Conflict of interest: Dr. Falzon has nothing to disclose.

Conflict of interest: Dr. Migliori has nothing to disclose.

Conflict of interest: Dr. Pérez-Guzmán has nothing to disclose.

Conflict of interest: Dr. VARGAS has nothing to disclose.

Conflict of interest: Dr. Garcia-Garcia has nothing to disclose.

Conflict of interest: Dr. Ponce-De-León has nothing to disclose.

Conflict of interest: Dr. van der Walt has nothing to disclose.

Conflict of interest: Dr. Newell has nothing to disclose.

Conflict of interest: Dr. Osornio has nothing to disclose.