https://doi.org/10.4081/monaldi.2021.1705

Factors associated with loss to follow-up among people with tuberculosis in the country of Georgia: a cohort study

Vol. 91 No. 1 (2021)
Published: January 14, 2021
Tuberculosis, pulmonary tuberculosis, loss to follow-up
Abstract Views: 1536
PDF: 470
Supplementary: 85
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Natalia Adamashvili
n.adamashvili@ncdc.ge
https://orcid.org/0000-0002-2763-5888
National Center for Disease Control and Public Health, Tbilisi, Georgia.
Kristina Akopyan
https://orcid.org/0000-0003-0177-1870
Tuberculosis Research and Prevention Center NGO, Yerevan, Armenia.
Nestani Tukvadze
National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
Kostyantyn Dumchev
https://orcid.org/0000-0003-2862-4977
Ukrainian Institute of Public Health Policy, Kyiv, Ukraine.
Yuliia Sereda
https://orcid.org/0000-0002-4017-4561
World Health Organization, Regional Office for Europe, Copenhagen, Denmark.
Irma Khonelidze
National Center for Disease Control and Public Health, Tbilisi, Georgia.
Giorgi Kuchukhidze
https://orcid.org/0000-0003-2066-873X
World Health Organization, Regional Office for Europe, Copenhagen, Denmark.

Despite having universal access to tuberculosis (TB) treatment, loss to follow-up (LFU) rates remain high in Georgia, 6% among drug-susceptible TB (DS-TB) patients (2017 cohort) and 19% among drug-resistant TB (DR-TB) patients diagnosed in 2016. A cohort study was conducted to analyze secondary data from the Georgian National Tuberculosis Surveillance Database. Study population included adult (≥18 y.o.) patients with bacteriologically confirmed pulmonary TB who were enrolled in Georgian National TB program during 2015-2017. The outcome of interest was loss to follow-up, defined as treatment interruption for more than 2 consecutive months. Patients were stratified by treatment profile (first-line drugs or second-line drugs) and survival analysis was performed within the stratified groups.  A total of 7860 treatment episodes were identified during 2015-2017 which corresponded to 6696 bacteriologically confirmed pulmonary TB treatment episodes of whom 795 (12%) were LFU. After adjustment, final multivariate analysis showed that male sex (aHR 1.5, 95%CI 1.2-2.0), being diagnosed in Tbilisi (aHR 1.3, 95%CI 1.1-1.6), unemployment at the time of diagnosis (aHR 1.7, 95%Ci 1.2-2.3) and previous history of TB treatment were independent risk factors for  LFU (aHR 2.3, 95%CI 1.9-2.8) among patients on first-line drugs. Among patients on second-line drugs being male (aHR 2.0, 95%CI 1.2-3.2), past TB treatment with second-line drugs (aHR 2.2, 95%CI 1.5-3.2) were significantly associated with LFU. LFU rate was high among patients on first-line drugs and second line drugs (10% and 22% respectively). Patients with past TB treatment history should further research to identify factors that lead to treatment interruption in this group. Other factors associated with LFU (being internally displaced person (IDP), being unemployed, and having imprisonment history) were in some level indication of a poor social-economic status, and strengthening approaches for TB care based on patients’ need could be considered in light of this finding.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
WHO. Global tuberculosis report 2019. Geneva: World Health Organization; 2020. Available from: http://www.who.int/tb/publications/global_report/en/
WHO. Definitions and reporting framework for tuberculosis-2013 Revision; 2013. Accessed on: 2019 Nov 22. Available from: https://apps.who.int/iris/bitstream/handle/10665/79199/9789241505345_eng.pdf;jsessionid=A22FF4F90750CDEF883825A85CB3A48B?sequence=1
WHO Regional Office for Europe. Tuberculosis surveillance and monitoring report in Europe 2020. Available from: https://www.euro.who.int/en/publications/abstracts/tuberculosis-surveillance-and-monitoring-report-in-europe-2020
WHO. WHO Consolidated guidelines on drug-resistant tuberculosis treatment. 2019. Accessed on: 2019 Nov 22. Available from: https://www.who.int/tb/publications/2019/consolidated-guidelines-drug-resistant-TB-treatment/en/
Tupasi TE, Garfin AMCG, Kurbatova EV, et al. Factors associated with loss to follow-up during treatment for multidrug-resistant tuberculosis, the Philippines, 2012-2014. Emerg Infect Dis 2016;22:491-502.
Wohlleben J, Makhmudova M, Saidova F, et al. Risk factors associated with loss to follow-up from tuberculosis treatment in Tajikistan: A case-control study. BMC Infect Dis 2017;17:543.
Schnaubelt ER, Charles M, Richard M, et al. Loss to follow-up among patients receiving anti-tuberculosis treatment, Haiti, 2011–2015. Public Heal Action 2019;8:154-61.
Kuchukhidze G, Kumar AMV, de Colombani P, et al. Risk factors associated with loss to follow-up among multidrug-resistant tuberculosis patients in Georgia. Public Health Action 2014;4:S41-6.
Adamashvili N, Kuchukhidze G, Baliashvili D, et al. Long-term outcomes of patients lost to follow-up from multidrug-resistant tuberculosis treatment in the country of Georgia. Proceedings 48th World Conference on Lung Health, 2017, Guadalajara, Abstract SOA-415-13.
World Bank. World Bank, Country Profile, Georgia. 2019. Available from: https://data.worldbank.org/country/georgia
WHO. National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia. Accessed on: 2019 Nov 22. Available from: https://www.who.int/workforcealliance/members_partners/member_list/tbgeo/en/.
WHO. Tuberculosis Country Brief, 2016 Georgia. Accessed on: 2019 Nov 22. Available from: http://www.euro.who.int/en/health-topics/communicable-diseases/tuberculosis/publications/2017/tuberculosis-
Javaid A, Shaheen Z, Shafqat M, et al. Risk factors for high death and loss-to-follow-up rates among patients with multidrug-resistant tuberculosis at a programmatic management unit. Am J Infect Control 2017;45:190-3.
Hirasen K, Berhanu R, Evans D, et al. High rates of death and loss to follow-up by 12 months of rifampicin resistant TB treatment in South Africa. PLoS One 2018;13:e0205463.
Mulongeni P, Hermans S, Caldwell J, et al. HIV prevalence and determinants of loss-to-follow-up in adolescents and young adults with tuberculosis in Cape Town. PLoS One 2019;14:e0210937.
Kliiman K, Altraja A. Predictors and mortality associated with treatment default in pulmonary tuberculosis. Int J Tuberc Lung Dis 2010;14:454-63.
Kendall EA, Theron D, Franke MF, et al. Alcohol, hospital discharge, and socioeconomic risk factors for default from multidrug resistant tuberculosis treatment in rural South Africa: a retrospective cohort study. PLoS One 2013;8:e83480.
Kristina Akopyan, Tuberculosis Research and Prevention Center NGO, Yerevan

National Center for Infectious Diseases, Yerevan, Armenia

How to Cite

Adamashvili, Natalia, Kristina Akopyan, Nestani Tukvadze, Kostyantyn Dumchev, Yuliia Sereda, Irma Khonelidze, and Giorgi Kuchukhidze. 2021. “Factors Associated With Loss to Follow-up Among People With Tuberculosis in the Country of Georgia: A Cohort Study”. Monaldi Archives for Chest Disease 91 (1). https://doi.org/10.4081/monaldi.2021.1705.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.