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Open Access Alarming rates of attrition among tuberculosis patients in public-private facilities in Lahore, Pakistan

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Setting: All public-private mix (PPM) facilities caring for tuberculosis (TB) patients in Lahore city, Pakistan, under four models: PPM1 (general practitioners), PPM2 (non-governmental organisations), PPM3 (private hospitals) and PPM4 (others).

Objective: To assess the pre-treatment loss to follow-up (LTFU), defined as patients documented in the laboratory registers but not in the treatment registers of any PPM facility, among sputum smear-positive TB patients diagnosed during January–March 2015, and unfavourable treatment outcomes among patients registered for treatment and associated factors.

Design: This was a retrospective cohort study reviewing existing programme records. Poisson regression was used to identify factors associated with outcomes.

Results: Of 2473 patients diagnosed, 1590 (64%) were lost to follow-up before treatment. This was higher among males (68%) and the elderly (79%), and lower among ‘high positives’ (smear grading 2+ or 3+, 53%) and in the PPM1 model (34%). Of 883 patients started on treatment, 165 (19%) had unfavourable outcomes: 8% LTFU, 5% treatment failure, 3% died and 3% not evaluated. Previously treated patients (34%) and children (44%) had the worst outcomes.

Conclusion: Pre-treatment LTFU was alarmingly high and requires urgent attention, including the development and institution of mechanisms for patient tracking using information and mobile phone technology, and making TB notification mandatory in the private sector.
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Keywords: PPM; SORT IT; operational research; pre-treatment loss to follow-up

Document Type: Research Article

Affiliations: 1: National Tuberculosis Control Program, Islamabad, Pakistan 2: International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India, The Union, Paris, France 3: College of Life and Environmental Science, Exeter University, Exeter, UK 4: Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India

Publication date: 21 June 2017

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  • Public Health Action (PHA), The Union's quarterly open access on-line journal, provides a platform for its mission 'Health solutions for the poor'. PHA addresses the need for show-casing operational research that addresses issues in health systems and services. It publishes high-quality scientific research that provides new knowledge to improve access, equity, quality and efficiency of health systems and services.

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