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Free Content Tuberculosis patients in primary care do not start treatment. What role do health system delays play?

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SETTING: Primary health care facilities in five provinces of South Africa.

OBJECTIVE: To investigate the association between the proportion of sputum results with a prolonged smear turnaround time and the proportion of smear-positive tuberculosis (TB) cases initially lost to follow-up.

DESIGN: The unit of investigation was a primary health care facility and the outcome was the initial loss to follow-up rate per facility, which was calculated by comparing the sputum register with the TB treatment register. A prolonged turnaround time was defined as more than 48 h from when the sputum sample was documented in the sputum register to receipt of the result at the facility.

RESULTS: The mean initial loss to follow-up rate was 25% (95%CI 22–28). Smear turnaround time overall was inversely associated with initial loss to follow-up (P = 0.008), when comparing Category 2 (33–66% turnaround time within 48 h) with Category 1 (0–32%) (OR 0.73, 95%CI 0.48–1.13, P = 0.163) and when comparing Category 3 (67–100%) with Category 1 (OR 0.62, 95%CI 0.39–0.99, P = 0.045). The population preventable fraction of initial loss to follow-up (when turnaround time was <48 h in ≥67% of smear results) was 21%.

CONCLUSION: Initial loss to follow-up should be reported as part of the TB programme to ensure that patients are initiated on treatment to prevent transmission within communities.

Keywords: initial loss to follow-up; tuberculosis; turnaround time

Document Type: Research Article


Affiliations: 1: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa; University of Amsterdam, Amsterdam, The Netherlands 2: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa 3: Biostatistics Unit, Medical Research Council, Cape Town, South Africa 4: International Union Against Tuberculosis and Lung Disease, Paris, France 5: University of Amsterdam, Amsterdam, The Netherlands

Publication date: 2013-05-01

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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