LOSS TO FOLLOW UP CASES IN TUBERCULOSIS PATIENTS AVAILING TREATMENT AT DISTRICT TUBERCULOSIS CENTRE, BARABANKI, UP
Main Article Content
Keywords
Tuberculosis, DOTS-TB Treatment, Loss to follow up, Barabanki, UP.
Abstract
Background: Tuberculosis (TB) remains a leading cause of death globally. Patients who get lost to follow-up (LTFU) during TB treatment have high risk of relapse, mortality, treatment failure and developing Multidrug resistant TB. Loss to follow-up during treatment is one of the major obstacles in the fight against tuberculosis, which has serious implications for patients, their families, communities, and health service providers. Indian government has implemented various strategies to track newly diagnosed tuberculosis (TB) cases and ensure follow-up for registered cases. Appropriate measures have been adapted to combat the spread of TB. Success of the treatment determines the effectiveness of the national TB control program. Hence, a study was aimed to investigate the factors associated with patient loss to follow-up (LTFU) during DOTS-TB treatment. This study was conducted using data from DOTS-TB registers of District Tuberculosis Centre, Barabanki, UP. Factors associated with LTFU were investigated using univariable and multivariable logistic regression. A total of 600 patients were registered for DOTS-TB treatment and eligible for inclusion between 1 April 2023 and 30 June 2025, of whom 92 (15.33%) were lost to follow-up. Conclusions: Loss to follow up pattern was seen more in urban patients, by gender more in male patients and by age groups observed more in older patients.
References
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24. Rosenstock IM: Historical origins of the Health Belief Model . Health Education Monographs. 1974, 2:328-
25. Garrido Mda S, Penna ML, Perez-Porcuna TM, et al.: Factors associated with tuberculosis treatment default in an endemic area of the Brazilian Amazon: a case control-study. PLoS One. 2012, 7:e39134.
26. Muture BN, Keraka MN, Kimuu PK, Kabiru EW, Ombeka VO, Oguya F: Factors associated with default from treatment among tuberculosis patients in Nairobi province, Kenya: a case control study. BMC Public Health. 2011, 11:696. 10.1186/1471-2458-11-696
27. Franke MF, Appleton SC, Bayona J, et al.: Risk factors and mortality associated with default from multidrug- resistant tuberculosis treatment. Clin Infect Dis. 2008, 46:1844-51. 10.1086/588292
28. Dodd PJ, Yuen CM, Sismanidis C, Seddon JA, Jenkins HE. The global burden of tuberculosis mortal- ity in children: a mathematical modelling study. Lancet Glob Health. 2017;5(9):e898–906.
29. Nliwasa M, MacPherson P, Gupta-Wright A, Mwapasa M, Horton K, Odland JØ, et al. High HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB: a system- atic review and meta-analyses. J Int AIDS Soc. 2018;21(7):e25162.
30. Odone A, Amadasi S, White RG, Cohen T, Grant AD, Houben RMGJ. The impact of antiretroviral therapy on mortality in HIV positive people during tuberculosis treatment: a systematic review and meta-analysis. PLoS One. 2014;9(11):e112017.
31. Sullivan A, Nathavitharana RR. Addressing TB-related mortality in adults living with HIV: a review of the challenges and potential solutions. Ther Adv Infect Dis. 2022;9:20499361221084163.
32. Ngari MM, Rashid MA, Sanga D, Mathenge H, Agoro O, Mberia JK, et al. Burden of HIV and treatment outcomes among TB patients in rural Kenya: a 9-year longitudinal study. BMC Infect Dis. 2023;23(1):362.
33. Volmink J, Garner P. Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev. 2006;(2):CD003343.
34. Jiang Y, Chen J, Ying M, Liu L, Li M, Lu S, et al. Factors associated with loss to follow-up before and after treatment initiation among patients with tuberculosis: A 5-year observation in China. Front Med (Lausanne). 2023;10:1136094.
35. Belay GM, Wubneh CA. Childhood tuberculosis treatment outcome and its association with HIV co-infection in Ethiopia: a systematic review and meta-analysis. Trop Med Health. 2020;48:7.
36. Birhane M, Mekonnen S, Dingeta T, Teklemariam Z. Loss to follow-up tuberculosis treatment and associated factors among adults attending at public health facilities in Warder District, Somali Regional State, Eastern Ethiopia. Front Public Health. 2023;11:1151077.
37. Kizito KW, Dunkley S, Kingori M, Reid T. Lost to follow up from tuberculosis treatment in an urban informal settlement (Kibera), Nairobi, Kenya: what are the rates and determinants?. Trans R Soc Trop Med Hyg. 2011;105(1):52–7.
38. Walker IF, Shi O, Hicks JP, Elsey H, Wei X, Menzies D, et al. Analysis of loss to follow-up in 4099 multidrug-resistant pulmonary tuberculosis patients. Eur Respir J. 2019;54(1):1800353.
39. Lima SVMA, de Araújo KCGM, Nunes MAP, Nunes C. Early identification of individuals at risk for loss to follow-up of tuberculosis treatment: A generalised hierarchical analysis. Heliyon. 2021;7(4):e06788.
40. Wikman-Jorgensen PE, Morales-Cartagena A, Llenas-García J, Pérez-Porcuna TM, Hobbins M, Ehmer J, et al. Implementation challenges of a TB programme in rural northern mozambique: evalua- tion of 2012-2013 outcomes. Pathog Glob Health. 2015;109(5):221–7.
41. Abdullahi OA, Ngari MM, Sanga D, Katana G, Willetts A. Mortality during treatment for tuberculosis; a review of surveillance data in a rural county in Kenya. PLoS One. 2019;14(7):e0219191.
42. Lumu I, Musaazi J, Semeere A, Handel I, Castelnuovo B. Survival and predictors of mortality after completion of TB treatment among people living with HIV: a 5-year analytical cohort. BMC Infect Dis. 2023;23(1):238.
43. Birhane M, Mekonnen S, DingetaT,Teklemariam Z. Loss to follow-up tuberculosis treatment and associated factors among adults attending at public health facilities in Warder District, Somali Regional State, Eastern Ethiopia. Front Public Health. 2024;12:1161077.
44. Mishra P, Sharma RK,Yadav R, RaoVG, Nigam S, Lingala MA, et al. Reasons for loss to follow-up (LTFU) of pulmonary TB (PTB) patients: a qualitative study among Saharia, a particularly vulnerable tribal group of Madhya Pradesh, India. PLoS One. 2021;16(12):e0261152.
2. Riojas MA, McGough KJ, Rider-Riojas CJ, Rastogi N, Hazbón MH. Phylogenomic analysis of the species of the Mycobacterium tuberculosis complex demonstrates that Mycobacterium africanum, Mycobacterium bovis, Mycobacterium caprae, Mycobacterium microti and Mycobacterium pinnipedii are later heterotypic synonyms of Mycobacterium tuberculosis. Int J Syst Evol Microbiol. 2018 Jan;68(1):324-332. https://doi.org/10.1099/ijsem.0.002507
3. Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India: Revised National Tuberculosis Control Programme. National Strategic Plan for Tuberculosis Elimination 2017-2025. Central TB Division (ed): Central TB Division, Nirman Bhawan, New Delhi, India; 2017. https://www.tbcindia.gov.in/WriteReadData/National%20Strategic%20Plan%202017- 25.pdf.
4. Nicholson TJ, Hoddinott G, Seddon JA, Claassens MM, van der Zalm MM, Lopez E, et al. A systematic review of risk factors for mortality among tuberculosis patients in South Africa. Syst Rev. 2023;12(1):23.
5. . WHO. Use of high burden country lists for TB by WHO in the post-2015. Geneva: WHO; 2015. Accessed and cited in November 2019. Available from: https://www.who.int/tb/publications/global_report/high_tb_ burdencountrylists2016-2020.pdf
6. World Health Organization. Global tuberculosis report 2023. Geneva: WHO, 2023.
7. Mundra A, Deshmukh PR, Dawale A: Magnitude and determinants of adverse treatment outcomes among tuberculosis patients registered under Revised National Tuberculosis Control Program in a Tuberculosis Unit, Wardha, Central India: A record-based cohort study. J Epidemiol Glob Health. 2017, 7:111-8. 10.1016/j.jegh.2017.02.002
8. Gordon SV and Parish T. Microbe Profile: Mycobacterium tuberculosis: Humanity’s deadly microbial foe. Microbiology; 2018;164:437–439
9. Global Tuberculosis Programme: Global Tuberculosis Report 2021. Global Tuberculosis Programme (ed): World Health Organization, Geneva; 2021. https://www.who.int/publications/i/item/9789240037021
10. Kant S, Singh AK, Parmeshwaran GG, Haldar P, Malhotra S, Kaur R: Delay in initiation of treatment after diagnosis of pulmonary tuberculosis in primary health care setting: eight year cohort analysis from district Faridabad, Haryana, North India. Rural Remote Health. 2017, 17:4158.
11. Ahmad S, Velhal G: Study of treatment interruption of new sputum smear-positive TB cases under DOTS strategy. Int J Med Sci Public Health. 2014, 3:977-81.
12. Karanjekar V, Lokare P, Gaikwad A, Doibale M, Gujrathi V, Kulkarni A: Treatment outcome and follow-up of tuberculosis patients put on directly observed treatment short-course under Rural Health Training Center, Paithan, Aurangabad in India. Ann Med Health Sci Res. 2014, 4:222-6.
13. Pandit S, Dey A, Chaudhuri AD, et al.: Five-years experiences of the Revised National Tuberculosis Control Programme in northern part of Kolkata, India. Lung India. 2009, 26:109-13.
14. Krishnan A, Kapoor SK: Involvement of private practitioners in tuberculosis control in Ballabgarh, Northern India. Int J Tuberc Lung Dis. 2006, 10:264-9.
15. Jaiswal A, Singh V, Ogden JA, et al.: Adherence to tuberculosis treatment: lessons from the urban setting of Delhi, India. Trop Med Int Health. 2003, 8:625-33.
16. Jayachandran V: A case study on tuberculosis treatment defaulters in Delhi: Weak health links of the community with the public sector, unsupported migrants and some misconceptions. Annals of Tropical Medicine and Public Health. 2014, 7:124.
17. Shiotani R, Hennink M: Socio-cultural influences on adherence to tuberculosis treatment in rural India . Glob Public Health. 2014, 9:1239-51.
18. Shringarpure KS, Isaakidis P, Sagili KD, Baxi RK, Das M, Daftary A: "When treatment is more challenging than the disease": a qualitative study of MDR-TB patient retention. PLoS One. 2016, 11:e0150849.
19. Velavan A, Purty AJ, Shringarpure K, et al.: Tuberculosis retreatment outcomes and associated factors: a mixed-methods study from Puducherry, India. Public Health Action. 2018, 8:187-93.
20. Chida N, Ansari Z, Hussain H, Jaswal M, Symes S, Khan AJ, Mohammed S: Determinants of default from tuberculosis treatment among patients with drug-susceptible tuberculosis in Karachi, Pakistan: a mixed methods study. PLoS One. 2015, 10:e0142384.
21. Martins N, Grace J, Kelly PM: An ethnographic study of barriers to and enabling factors for tuberculosis treatment adherence in Timor Leste. Int J Tuberc Lung Dis. 2008, 12:532-7.
22. Hasker E, Khodjikhanov M, Sayfiddinova S, et al.: Why do tuberculosis patients default in Tashkent City, Uzbekistan? A qualitative study. Int J Tuberc Lung Dis. 2010, 14:1132-9.
23. Munro SA, Lewin SA, Smith HJ, Engel ME, Fretheim A, Volmink J: Patient adherence to tuberculosis treatment: a systematic review of qualitative research. PLoS Med. 2007, 4:e238.
24. Rosenstock IM: Historical origins of the Health Belief Model . Health Education Monographs. 1974, 2:328-
25. Garrido Mda S, Penna ML, Perez-Porcuna TM, et al.: Factors associated with tuberculosis treatment default in an endemic area of the Brazilian Amazon: a case control-study. PLoS One. 2012, 7:e39134.
26. Muture BN, Keraka MN, Kimuu PK, Kabiru EW, Ombeka VO, Oguya F: Factors associated with default from treatment among tuberculosis patients in Nairobi province, Kenya: a case control study. BMC Public Health. 2011, 11:696. 10.1186/1471-2458-11-696
27. Franke MF, Appleton SC, Bayona J, et al.: Risk factors and mortality associated with default from multidrug- resistant tuberculosis treatment. Clin Infect Dis. 2008, 46:1844-51. 10.1086/588292
28. Dodd PJ, Yuen CM, Sismanidis C, Seddon JA, Jenkins HE. The global burden of tuberculosis mortal- ity in children: a mathematical modelling study. Lancet Glob Health. 2017;5(9):e898–906.
29. Nliwasa M, MacPherson P, Gupta-Wright A, Mwapasa M, Horton K, Odland JØ, et al. High HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB: a system- atic review and meta-analyses. J Int AIDS Soc. 2018;21(7):e25162.
30. Odone A, Amadasi S, White RG, Cohen T, Grant AD, Houben RMGJ. The impact of antiretroviral therapy on mortality in HIV positive people during tuberculosis treatment: a systematic review and meta-analysis. PLoS One. 2014;9(11):e112017.
31. Sullivan A, Nathavitharana RR. Addressing TB-related mortality in adults living with HIV: a review of the challenges and potential solutions. Ther Adv Infect Dis. 2022;9:20499361221084163.
32. Ngari MM, Rashid MA, Sanga D, Mathenge H, Agoro O, Mberia JK, et al. Burden of HIV and treatment outcomes among TB patients in rural Kenya: a 9-year longitudinal study. BMC Infect Dis. 2023;23(1):362.
33. Volmink J, Garner P. Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev. 2006;(2):CD003343.
34. Jiang Y, Chen J, Ying M, Liu L, Li M, Lu S, et al. Factors associated with loss to follow-up before and after treatment initiation among patients with tuberculosis: A 5-year observation in China. Front Med (Lausanne). 2023;10:1136094.
35. Belay GM, Wubneh CA. Childhood tuberculosis treatment outcome and its association with HIV co-infection in Ethiopia: a systematic review and meta-analysis. Trop Med Health. 2020;48:7.
36. Birhane M, Mekonnen S, Dingeta T, Teklemariam Z. Loss to follow-up tuberculosis treatment and associated factors among adults attending at public health facilities in Warder District, Somali Regional State, Eastern Ethiopia. Front Public Health. 2023;11:1151077.
37. Kizito KW, Dunkley S, Kingori M, Reid T. Lost to follow up from tuberculosis treatment in an urban informal settlement (Kibera), Nairobi, Kenya: what are the rates and determinants?. Trans R Soc Trop Med Hyg. 2011;105(1):52–7.
38. Walker IF, Shi O, Hicks JP, Elsey H, Wei X, Menzies D, et al. Analysis of loss to follow-up in 4099 multidrug-resistant pulmonary tuberculosis patients. Eur Respir J. 2019;54(1):1800353.
39. Lima SVMA, de Araújo KCGM, Nunes MAP, Nunes C. Early identification of individuals at risk for loss to follow-up of tuberculosis treatment: A generalised hierarchical analysis. Heliyon. 2021;7(4):e06788.
40. Wikman-Jorgensen PE, Morales-Cartagena A, Llenas-García J, Pérez-Porcuna TM, Hobbins M, Ehmer J, et al. Implementation challenges of a TB programme in rural northern mozambique: evalua- tion of 2012-2013 outcomes. Pathog Glob Health. 2015;109(5):221–7.
41. Abdullahi OA, Ngari MM, Sanga D, Katana G, Willetts A. Mortality during treatment for tuberculosis; a review of surveillance data in a rural county in Kenya. PLoS One. 2019;14(7):e0219191.
42. Lumu I, Musaazi J, Semeere A, Handel I, Castelnuovo B. Survival and predictors of mortality after completion of TB treatment among people living with HIV: a 5-year analytical cohort. BMC Infect Dis. 2023;23(1):238.
43. Birhane M, Mekonnen S, DingetaT,Teklemariam Z. Loss to follow-up tuberculosis treatment and associated factors among adults attending at public health facilities in Warder District, Somali Regional State, Eastern Ethiopia. Front Public Health. 2024;12:1161077.
44. Mishra P, Sharma RK,Yadav R, RaoVG, Nigam S, Lingala MA, et al. Reasons for loss to follow-up (LTFU) of pulmonary TB (PTB) patients: a qualitative study among Saharia, a particularly vulnerable tribal group of Madhya Pradesh, India. PLoS One. 2021;16(12):e0261152.
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Aug 13, 2025
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Dr. Rimjhim Sinha, Dr. Manindra Pratap Singh, Dr. Ankur Srivastava, & Dr. Shwetambari Srivastava. (2025). LOSS TO FOLLOW UP CASES IN TUBERCULOSIS PATIENTS AVAILING TREATMENT AT DISTRICT TUBERCULOSIS CENTRE, BARABANKI, UP. Journal of Population Therapeutics and Clinical Pharmacology, 32(7), 496-510. https://doi.org/10.53555/jeza0z12
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Author Biographies
Dr. Rimjhim Sinha
Junior Resident-3, Department of Community Medicine, Hind Institute of Medical Science, Safedabad, Barabanki, UP, India.
Dr. Manindra Pratap Singh
Professor, Department of Community Medicine, Hind Institute of Medical Science, Safedabad, Barabanki, UP, India.
Dr. Ankur Srivastava
Professor, Department of Community Medicine, Hind Institute of Medical Science, Safedabad, Barabanki, UP, India.
Dr. Shwetambari Srivastava
Assistant Professor, Department of Community Medicine, Hind Institute of Medical Science, Safedabad, Barabanki, UP, India.
How to Cite
Dr. Rimjhim Sinha, Dr. Manindra Pratap Singh, Dr. Ankur Srivastava, & Dr. Shwetambari Srivastava. (2025). LOSS TO FOLLOW UP CASES IN TUBERCULOSIS PATIENTS AVAILING TREATMENT AT DISTRICT TUBERCULOSIS CENTRE, BARABANKI, UP. Journal of Population Therapeutics and Clinical Pharmacology, 32(7), 496-510. https://doi.org/10.53555/jeza0z12