Speaker Biography

Hamufare Mugauri

Ministry of Health and Child Care, AIDS and TB Unit Zimbabwe

Title: Searching for people with bacteriologically-confirmed pulmonary tuberculosis: loss to follow-up, death and delay before treatment initiation in Bulawayo, Zimbabwe (2012-2016)

Hamufare Mugauri
Biography:

Abstract:

Background: Tuberculosis (TB) is the single most important cause of death from an infectious disease in Zimbabwe, whose eradication is dependent on the identification of all infected patients and their subsequent commencement on treatment. Diagnosed patients who do not initiate treatment facilitate onward transmission of the infection. This study quantified and assessed risk factors for loss to follow up (LTFU) and delays before treatment initiation among bacteriologically confirmed pulmonary TB patients.

Methods: A cohort study was conducted using routinely collected programme data from Bulawayo city, Zimbabwe. Diagnosed patients were identified from the laboratory register for 2012-2016, tracked for treatment initiation in the City’s TB registers and missing entries ascertained their outcomes in presumptive TB registers at respective clinics. We defined pre-treatment LTFU as diagnosed patients who did not initiate treatment within 90 days and pre-treatment deaths. Multivariable analysis was used to identify risk factors for pre-treatment LTFU and delays.

Results: Out of 2,443 identified records, one in five patients (20.8%,n=508) were lost to follow-up, including pre-treatment deaths (10.3%). Above 65 year olds (a RR=2.71,95%CI;2.12,3.47), male gender (aRR=1.21,95%CI;1.04,1.41), HIV positivity (aRR=1.26,95%CI;1.02,1.56) or Unknown HIV status (aRR=4.78,95%CI; 3.80,6.00) were independent risk factors for pre-treatment LTFU. Delay between testing and dispatch of results by ≥ 3 days (aRR=1.42, 95%CI;1.09,1.85), was an independent risk factors for pre-treatnment death in addition to the above. Among registered patients, (n=1,935), the mean (SD) delay from diagnosis to treatment initiation was 29.1 (21.6) days. Independent risk factors for treatment delay were new TB type (β=13.5,95%CI;11.5,15.4) and the delay decreased between 2013 (β=-8.8,95%CI;-11.5,-6.1) and 2016 (β=-18.6, 95%CI;-21.7,-15.6).

Conclusions: High loss to follow-up, deaths and delay of TB treatment initiation observed in this study is cause for concern. Enhancing active case finding, patient tracking from diagnosis to treatment initiation and point of care diagnosis were mitigatory strategies identified for risk factors for pre-treatment LTFU/death and delay.