Abstract
Introduction: In Malaysia, loss to follow-up (LTFU) comprises approximately one-quarter of all unsuccessful treatment outcomes among tuberculosis (TB) patients over the recent years. Evidence on determinants for LTFU among TB patients in the local context remains limited, although it is important for the monitoring and evaluation of the national TB control programme, including identifying areas for improvement and informing future strategies to address this outcome.
Methods: A retrospective cohort study was conducted using population-level data from Malaysia's national TB surveillance data from 2014 until 2017. Data on socio-demographic characteristics and TB disease variables were extracted to investigate for potential association with LTFU among TB patients using multiple logistic regression analysis. Additionally, a qualitative study was conducted in Johor to explore reasons for leaving TB care among TB patients with a history of LTFU. In this qualitative study, a total of 15 in-depth interviews involving 15 TB patients were conducted between January and September 2020. Results: A total of 97,505 TB cases were included for analysis, of which 5.3% (n=5,161) were LTFU during TB treatment. LTFU was significantly associated with younger age (adjusted odds ratio, AOR 0.98, 95% CI 0.98, 0.99), male sex (AOR 1.87, 95% CI 1.73, 2.03), Malaysians (AOR 2.44, 95% CI 2.12, 2.81), urban residence (AOR 1.80, 95% CI 1.70, 1.92), lower education levels (no formal education having highest AOR 1.83, 95% 1.61, 2.09), no diabetes mellitus (AOR 1.15, 95% CI 1.05, 1.25), smoking (AOR 1.52, 95% CI 1.43, 1.63), previous treatment for TB (treatment after LTFU having highest AOR 5.26, 95% CI 4.74, 5.83), smear-positive TB (AOR 1.19, 95% CI 1.11, 1.28), and human immunodeficiency virus co-infection (AOR 1.48, 95% CI 1.35, 1.63). In the qualitative study, a total of 11 emerging themes were identified. The themes occurred at four levels of interaction with TB patients; TB beliefs, the role of traditional and complementary medicine, and substance abuse occurred at the patient level; financial, logistic, and work-related factors at the structural level; TB medications' side effects, healthcare system and healthcare professional factors at the healthcare level; and the role of family and interpersonal interaction at the interpersonal or societal level.
Discussion: Study findings reiterate the need for and guide the means to address LTFU among TB patients in Malaysia. The quantitative findings may contribute to identifying subpopulations with higher likelihoods for LTFU, while the qualitative findings provide a better understanding of the underlying issues contributing to LTFU among TB patients. Together, these findings can benefit future strategies in TB control, particularly in the planning and implementation of targeted strategies and public health actions that are responsive to addressing LTFU among TB patients in Malaysia.
Links
- https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-O-35.pdf
- https://apcph.cphm.my/events/oral-session-5-ballroom-B/
BibTeX (Download)
@proceedings{APCPH2022-O-35,
title = {Loss to follow-up among TB patients in Malaysia: who are they, and why did it happen?},
author = {Peter Seah Keng Tok and Tharani Loganathan and Li Ping Wong and Su May Liew and Asmah Razali and Thilaka Chinnayah and Shaharom Nor Azian Che Mat Din},
url = {https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-O-35.pdf
https://apcph.cphm.my/events/oral-session-5-ballroom-B/},
year = {2022},
date = {2022-08-01},
urldate = {2022-08-02},
issue = {7},
abstract = {Introduction: In Malaysia, loss to follow-up (LTFU) comprises approximately one-quarter of all unsuccessful treatment outcomes among tuberculosis (TB) patients over the recent years. Evidence on determinants for LTFU among TB patients in the local context remains limited, although it is important for the monitoring and evaluation of the national TB control programme, including identifying areas for improvement and informing future strategies to address this outcome.
Methods: A retrospective cohort study was conducted using population-level data from Malaysia's national TB surveillance data from 2014 until 2017. Data on socio-demographic characteristics and TB disease variables were extracted to investigate for potential association with LTFU among TB patients using multiple logistic regression analysis. Additionally, a qualitative study was conducted in Johor to explore reasons for leaving TB care among TB patients with a history of LTFU. In this qualitative study, a total of 15 in-depth interviews involving 15 TB patients were conducted between January and September 2020. Results: A total of 97,505 TB cases were included for analysis, of which 5.3% (n=5,161) were LTFU during TB treatment. LTFU was significantly associated with younger age (adjusted odds ratio, AOR 0.98, 95% CI 0.98, 0.99), male sex (AOR 1.87, 95% CI 1.73, 2.03), Malaysians (AOR 2.44, 95% CI 2.12, 2.81), urban residence (AOR 1.80, 95% CI 1.70, 1.92), lower education levels (no formal education having highest AOR 1.83, 95% 1.61, 2.09), no diabetes mellitus (AOR 1.15, 95% CI 1.05, 1.25), smoking (AOR 1.52, 95% CI 1.43, 1.63), previous treatment for TB (treatment after LTFU having highest AOR 5.26, 95% CI 4.74, 5.83), smear-positive TB (AOR 1.19, 95% CI 1.11, 1.28), and human immunodeficiency virus co-infection (AOR 1.48, 95% CI 1.35, 1.63). In the qualitative study, a total of 11 emerging themes were identified. The themes occurred at four levels of interaction with TB patients; TB beliefs, the role of traditional and complementary medicine, and substance abuse occurred at the patient level; financial, logistic, and work-related factors at the structural level; TB medications' side effects, healthcare system and healthcare professional factors at the healthcare level; and the role of family and interpersonal interaction at the interpersonal or societal level.
Discussion: Study findings reiterate the need for and guide the means to address LTFU among TB patients in Malaysia. The quantitative findings may contribute to identifying subpopulations with higher likelihoods for LTFU, while the qualitative findings provide a better understanding of the underlying issues contributing to LTFU among TB patients. Together, these findings can benefit future strategies in TB control, particularly in the planning and implementation of targeted strategies and public health actions that are responsive to addressing LTFU among TB patients in Malaysia.},
howpublished = {published online at https://apcph.cphm.my},
note = {Type: ORAL PRESENTATION; Organisation: Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia; Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya; Department of Primary Care Medicine, Faculty of Medicine, University of Malaya; TB/Leprosy Sector, Disease Control Division, Ministry of Health Malaysia; Johor State Health Department, Ministry of Health Malaysia},
keywords = {loss to follow-up, Malaysia, treatment outcome, tuberculosis},
pubstate = {published},
tppubtype = {proceedings}
}