Multidrug-resistant tuberculosis patients lost to follow-up: self-reported readiness to restart treatment

Abstract

Setting: Multidrug-resistant tuberculosis (MDR-TB) patients lost to follow-up (LTFU) from Programmatic Management of Drug-resistant Tuberculosis facilities in the Philippines.

Objectives: To gain insight into patients' readiness to return to treatment.

Methods: MDR-TB patients who initiated treatment and were categorized as LTFU were identified using TB registers, contacted, and asked to consent to an interview and medical record review. At the conclusion of the interview, patients' readiness to restart treatment was assessed and examined in relation to demographic, clinical, and interview data. Odds ratios were calculated.

Results: When asked if they would consider restarting MDR-TB treatment, 3% of the 89 participating patients reported that they had already restarted, 34% indicated that they wanted to restart, 33% had not considered restarting, 28% were undecided, and 2% had decided against restarting. Patients who wanted to restart treatment were more likely to report having borrowed money for TB-related expenses (OR 5.97, 95%CI 1.27-28.18), and were less likely to report being self-employed (OR 0.08, 95%CI 0.01-0.67), or perceive themselves at low or no risk for TB relapse (OR 0.30, 95%CI 0.08-0.96) than patients who did not indicate an interest in restarting treatment.

Conclusions: Efforts to re-engage LTFU patients in care should consider financial barriers, knowledge gaps, and personal adherence challenges in patients.

Figure A

Study population. * Study exclusion criteria were incarceration, age <18 years, enrollment in pharmaceutical clinical trials, and major psychiatric disorder or physical incapacitation. ^† Controls who did not provide consent were replaced by other randomly selected eligible patients. MDR-TB = multidrug-resistant TB; LTFU =lost to follow-up; TB = tuberculosis.