Lost to Follow – Up During Diagnosis (LTFU) of Tuberculosis Patients: A Mixed Method Study on Determinant’s and Potential Solutions

Abstract

Background: Loss to follow up of tuberculosis patient during diagnosis is an important barrier to achieve elimination of TB by 2025 in India. This study estimated the burden and trend of loss to follow up of TB patient during diagnosis, explored tuberculosis patient’s perspective for becoming Loss To Follow Up during diagnostic period (LTFU) and stakeholders’ initiatives and suggested solutions for the same. Methods: Mixed Method study was used - Quantitative (Record based cohort study) and Qualitative (In – depth interview with LTFU patients on their challenges faced and barriers for not giving 2nd sputum sample and free list with stakeholders). Data were extracted from RNTCP Laboratory Register for the cohort of patients registered between January 2014 and December 2018 in a DMC of tertiary care teaching hospital. Qualitative interviews were carried out using interview guide. Results: Of the total 1678 positive cases, 90 (5.3%) were LTFU. On adjusted analysis distance >75km from medical college (Relative risk 2.3; 95%CI: 1.2-4.3) and year of diagnosis were identified as significant risk factors. In Manual content analysis showed five categories of challenges faced by LTFU cases namely 1) lack of awareness; 2) addictions; 3) stigma; 4) Employment related barriers and 5) perception on drug side effects. Free listing conducted between staffs of hospital and from stakeholders the main suggested solutions identified were 1) context-based counselling; 2) friendly patient tracking; and 3) proactive in-service. Conclusion: There was significantly decreasing trend in LTFU patients over the years (in 2014 – 6% to 0.5% in 2018). Co-ordinated context-specific pro-active interventions are required to achieve End TB strategy of the nation

Keywords

• mixed methods research
• suggested solutions
• lost to follow up