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: 1837
PDF: 485
Supplementary: 86
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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.

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Citations

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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.

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