Factors associated with loss to follow-up in tuberculosis treatment in Brazil: a retrospective cohort study

Abstract

Objective: To analyze the factors associated with loss to follow-up in tuberculosis cases among adults in Brazil in 2020 and 2021. Method: Retrospective cohort with secondary data from the Brazilian Notifiable Diseases Information System. A total of 24,344 people diagnosed with tuberculosis whose information was complete in the database were included. Adjusted odds ratios and confidence intervals were estimated by binary logistic regression. Results: Higher odds of loss to follow-up were observed for males, non-white ethnicity/color, with lower education level, homeless or deprived of liberty, who used drugs, alcohol and/or tobacco, with admission due to recurrence or re-entry after abandonment, and with unknown or positive serology for HIV. On the other hand, older age, extrapulmonary tuberculosis, deprivation of libertyand supervised treatment were associated with lower odds of loss to follow-up. Conclusion: Demographic, socioeconomic and clinical-epidemiological factors were associated with the loss to follow-up in tuberculosis cases, which reiterates the various vulnerabilities intertwined with the illness and treatment of this disease. Therefore, there is a need to promote strategies aimed at adherence and linkage to the care for groups most vulnerable to loss to follow-up in tuberculosis treatment in Brazil.

A critical analysis of the decreasing trends in tuberculosis cure indicators in Brazil, 2001–2022

“…(20) In the Brazilian context, a retrospective cohort study identified factors leading to loss of follow-up for tuberculosis treatment when compared with the cure outcome. (21) Among the vulnerabilities, the following stood out: male gender (adjusted OR [aOR] = 1.35; 95% CI: 1.23-1.46); non-white ethnicity/race (aOR = 1.16; 95% CI: 1.07-1.26); drug use (aOR = 1.84; 95% CI: 1.66-2.04); and entry as recurrence (aOR = 1.33; 95% CI: 1.15-1.53) or re-entry after abandonment (aOR = 4.31; 95% CI: 3.90-4.77). (21) To achieve the goals of reducing new cases and deaths from the disease by 2030, it is necessary and urgent to advance and overcome existing care gaps.…”

“…(21) Among the vulnerabilities, the following stood out: male gender (adjusted OR [aOR] = 1.35; 95% CI: 1.23-1.46); non-white ethnicity/race (aOR = 1.16; 95% CI: 1.07-1.26); drug use (aOR = 1.84; 95% CI: 1.66-2.04); and entry as recurrence (aOR = 1.33; 95% CI: 1.15-1.53) or re-entry after abandonment (aOR = 4.31; 95% CI: 3.90-4.77). (21) To achieve the goals of reducing new cases and deaths from the disease by 2030, it is necessary and urgent to advance and overcome existing care gaps. To this end, we suggest expanding diagnostic testing, timely and adequate reporting of new cases, guaranteeing general access to health care for treatment follow-up, mitigation of disease risk factors (focusing on countries with the highest burden and among vulnerable populations), and expanding investments in research.…”

“…Directly observed treatment, for example, has been crucial to guarantee the bond between health professionals and affected people, allowing early identification of possible loss to follow-up and favoring the chances of curing the disease. (21,23,24) Federative Furthermore, to effectively combat tuberculosis, it is crucial to reinforce actions aimed at controlling and managing cases of latent Mycobacterium tuberculosis infection (LTBI), also known as tuberculosis infection. (25) In these situations, people are not sick, but when exposed to risk factors, such as immunosuppression or malnutrition, they can develop an active condition, and, eventually, spread tuberculosis among contacts, maintaining the transmission chain.…”

Time until tuberculosis recurrence and associated factors in Brazil: a populationbased retrospective cohort study using a linked database

“…Our data show a significant rate of recurrence attributed to males and individuals aged over 15 years old. Notably, men are more likely to engage in behaviors, such as difficulties in identifying their health demands and the non-adoption of protective practices, that can lead to unfavorable treatment outcomes (e.g., loss to follow-up) 4,19,20 . This could explain the higher proportion of TB recurrence in this group.…”

“…In 2022, the TB incidence rate in Brazil was 37.4 cases per 100,000 inhabitants, with a mortality rate of 2.61 deaths per 100,000 inhabitants 2 . The country faces numerous challenges in controlling the disease, such as healthcare resource inequalities, low education levels, income and occupation disparities, high population density in vulnerable socioeconomic territories, poor living conditions, and elevated loss to follow-up rates that sustain the transmission chain 3,4 .…”