Factors Associated with Loss to Follow-up during Treatment for Multidrug-Resistant Tuberculosis, the Philippines, 2012-2014

Abstract

To identify factors associated with loss to follow-up during treatment for multidrug-resistant (MDR) tuberculosis (TB) in the Philippines, we conducted a case-control study of adult patients who began receiving treatment for rifampin-resistant TB during July 1-December 31, 2012. Among 91 case-patients (those lost to follow-up) and 182 control-patients (those who adhered to treatment), independent factors associated with loss to follow-up included patients' higher self-rating of the severity of vomiting as an adverse drug reaction and alcohol abuse. Protective factors included receiving any type of assistance from the TB program, better TB knowledge, and higher levels of trust in and support from physicians and nurses. These results provide insights for designing interventions aimed at reducing patient loss to follow-up during treatment for MDR TB.

Keywords: MDR TB; TB; follow-up; multidrug-resistant tuberculosis; patient compliance; risk factors; side effects; the Philippines; treatment; tuberculosis and other mycobacteria.

Figure 1

Selection of participants for study of loss to follow-up during treatment for multidrug resistant tuberculosis (MDR TB) in the Philippines, 2012–2014. *Study exclusion criteria were incarceration, age <18 years, enrollment in pharmaceutical clinical trials, and major psychiatric disorder or physical incapacitation. †Control-patients who did not give consent for the study were replaced by other randomly selected eligible patients.

Figure 2

Social ecologic model used to identify factors influencing loss to follow-up during treatment for multidrug resistant tuberculosis in the Philippines, 2012–2014. Boldface indicates data collected through patient interviews and medical record abstractions. DOTS, directly observed therapy.