Pre-treatment loss to follow-up and associated factors among drug-resistant tuberculosis patients diagnosed in Wakiso District, Uganda

Abstract

Background: Tuberculosis (TB) remains a formidable global health challenge, claiming millions of lives annually and ranking among the top ten causes of death worldwide. The emergence of drug-resistant TB (DR-TB) further complicates efforts for control and eradication. Pre-treatment loss to follow-up (LTFU) is the failure to initiate appropriate treatment for diagnosed DR-TB patients which signifies a setback from timely intervention to prevent disease progression and transmission. This study assessed the magnitude and associated factors of pre-treatment LTFU among DR-TB patients in Wakiso District, Uganda. Purpose: To assess the prevalence and associated factors of pre-treatment Loss to follow-up among Drug-resistant Tuberculosis patients in Wakiso district. Method: This was a sequential explanatory mixed methods study using electronic case-based surveillance (eCBSS) data from 2017-2022, involving 253 DR-TB patient records aged 18 years and , six (6) key informant interviews (KIIs) with Health workers under TB program and two (2) focused group discussions (FGDs) with DR-TB patients, aimed at explaining factors or pre-treatment LTFU. Qualitative participants comprised of eight (8) males and ten (10) females, aged between 24 and 52 years. Results: A total of 253 patient records were analyzed, with 157 (62%) being male and the participants' age ranged from 18 to 85 years, with a median age of 34 years. The prevalence of pretreatment LTFU was 13.4% (34/253). Factors associated with pre-treatment LTFU included; tobacco use (adjusted PR 1.96 95% CI 1.00-3.87); other illicit drug misuse elements (adjusted PR 4.00, 95% CI 1.76-9.08). previous treatment failure category (adjusted PR 1.69, 95%CI 0.78-3.70) indicated the trend towards a higher likelihood of pretreatment LTFU among individuals with a history of previous treatment failure compared to those without such a history. Recorded home address (adjusted PR 0.52 (95% CI 0.27-0.97); registered phone number (adjusted PR 0.47,95%CI 0.27-0.80) were protective to pre-treatment LTFU. Qualitative findings revealed elements such as fear, denial of diagnosis, lack of awareness, feeling healthy, diagnostic delays, stock-outs, communication gaps, stigma, family support and poverty. Conclusion: The prevalence of pre-treatment LTFU was 13.4%, slightly lower than the national average of 15%. Contributing factors included inadequate contact information, prior treatment failure, and tobacco, drug abuse, diagnostic delays, stigma and other social-economical barriers. A comprehensive understanding of patient-related determinants, health system factors, and social determinants is crucial to enhance treatment initiation and adherence.