Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in Uganda
Abstract Background 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 pretreatmen...
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doaj-d431958ff3df476ea6149cec241f5a672020-12-06T12:04:59ZengBMCBMC Public Health1471-24582020-12-012011810.1186/s12889-020-09955-0Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in UgandaStella Zawedde-Muyanja0Achilles Katamba1Adithya Cattamanchi2Barbara Castelnuovo3Yukari C. Manabe4The Infectious Diseases Institute, College of Health Sciences, Makerere UniversityDepartment of Medicine, School of Medicine, Makerere University College of Health SciencesDivision of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San FranciscoThe Infectious Diseases Institute, College of Health Sciences, Makerere UniversityDivision of Infectious Diseases, Department of Medicine, Johns Hopkins University School of MedicineAbstract Background 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.https://doi.org/10.1186/s12889-020-09955-0Pretreatment loss to follow-upXpert testingTuberculosisUganda |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Stella Zawedde-Muyanja Achilles Katamba Adithya Cattamanchi Barbara Castelnuovo Yukari C. Manabe |
spellingShingle |
Stella Zawedde-Muyanja Achilles Katamba Adithya Cattamanchi Barbara Castelnuovo Yukari C. Manabe 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 Pretreatment loss to follow-up Xpert testing Tuberculosis Uganda |
author_facet |
Stella Zawedde-Muyanja Achilles Katamba Adithya Cattamanchi Barbara Castelnuovo Yukari C. Manabe |
author_sort |
Stella Zawedde-Muyanja |
title |
Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in Uganda |
title_short |
Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in Uganda |
title_full |
Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in Uganda |
title_fullStr |
Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in Uganda |
title_full_unstemmed |
Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in Uganda |
title_sort |
patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using xpert® mtb/rif testing in uganda |
publisher |
BMC |
series |
BMC Public Health |
issn |
1471-2458 |
publishDate |
2020-12-01 |
description |
Abstract Background 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. |
topic |
Pretreatment loss to follow-up Xpert testing Tuberculosis Uganda |
url |
https://doi.org/10.1186/s12889-020-09955-0 |
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