Original Article

Risk Factors Associated with Lost to Follow up Among Multidrug Resistance Tuberculosis Patients Registered for Treatment in Programmatic Management of Drug Resistant Tuberculosis Sites of Punjab, Pakistan


Introduction: Pakistan, a country with a 27 high burden countries of multidrug resistance tuberculosis. To predict the associated risk factors and proportion of loss to follow up among MDR-TB patients treated at PMDT sites of Punjab from 2017 to 2019.
Methodology: This case control study based on the standardized reporting and recording case record forms called as Electronic Nominal Review System (ENRS) of National TB Control Program, Pakistan. A logistic regression model was used to assess risk factors of lost to follow up MDR-TB patients.
Results: A total of 539 patients with MDR-TB were included in the final analysis. Among them, 207 patients (7.5%) had lost to follow up outcome at the end of the study. MDR-TB lost to follow up patients were more likely to report older age (AOR: 1.40, CI: 1.14-1.71, p=0.000),  history of lost to follow up from first line drugs treatment (AOR: 0.39, CI: 0.28-0.56, p=0.000), co-morbid (AOR:1.54, CI: 1.24-1.91, p=0.000), adverse reaction of second line drugs (AOR: 0.45, CI: 0.37-0.56, p=0.000), long distance between patient’s home and PMDT site (AOR: 0.68, CI: 0.52-0.89, p=0.001).
Conclusion: The history of lost to follow up from first line drugs treatment, co-morbid, older age and long distance were independent risk factors of MDR-TB. Proper training for PMDT sites staff, friendly follow up services and psychological counseling may help to reduce lost to follow up.

1. World Health Organization (WHO), 2018. Global Tuberculosis report, Geneva, Switzerland.
2. TB-Control Program, Punjab: Health Reports, 2013. Available: http://www.health.punjab.gov.pk/?q=tb_con trol_program#Reports.
3. Shringarpure KS, Isaakidis P, Sagili KD, Baxi RK. Loss-To-Follow-Up on Multidrug Resistant Tuberculosis Treatment in Gujarat, India: The WHEN and WHO of It. Mistry N, ed. PLoS ONE. 2015;10(7):e0132543. doi:10.1371/journal.pone.0132543.
4. Chiang CY, Enarson DA, Yu MC, Bai KJ, Huang RM, Hsu CJ, et al. Outcome of pulmonary multidrug-resistant tuberculosis: a 6-yr follow-up study. Eur Respir J 2006; 28:980-5.
5. Kim HJ, Hong YP, Kim SJ, Lew WJ, Lee EG. Ambulatory treatment of multidrugresistant pulmonary tuberculosis patients at a chest clinic. Int J Tuberc Lung Dis 2001; 5: 1129-36.
6. Kuchukhidze G, Kumar AMV, de Colombani P, et al. Risk factors associated with loss to follow-up among multidrugresistant tuberculosis patients in Georgia. Public Health Action. 2014;4(Suppl 2):S41-S46. doi:10.5588/pha.14.0048.
7. Rao NA, Irfan M, Mahfooz Z. Treatment outcome of multi-drug resistant tuberculosis in a tertiary care centre in Karachi. J Pak Med Assoc.2009; 59:694.
8. Khurram M, Khaar HT, Fahim M. Multidrug-resistant tuberculosis in Rawalpindi, Pakistan. J Infect DevCtries.
9. National Tuberculosis Control Program. Programmatic Management ofDrug-resistant Tuberculosis (PMDT).
http://www.ntp.gov.pk/uploads/Programmatic Management of Drug resistant Tuberculosis PMDT.pdf.[Accessed 4 November 2018].
10. Franke M F, Appleton S C, Bayona J, et al. Risk factors and mortality associated with default from multidrug-resistant tuberculosis treatment. Clin Infect Dis 2008; 46: 1844–1851.
11. Akhtar AM, Arif MA, Kanwal S, Majeed S. Prevalence and drug resistance pattern of MDR-TB in retreatment cases of Punjab, Pakistan. JPMA 2016; 66 (8): 989-993.
12. Khurram, M., Khaar, H., & Fahim, M. 2011). Multidrug-resistant tuberculosis in Rawalpindi, Pakistan. The Journal Of Infection In Developing Countries, 6(01), 29-32. doi:10.3855/jidc.1738.
13. Brust JC, Gandhi NR, Carrara H, Osburn G, Padayatchi N. High treatment failure and default rates for patients with multidrugresistant tuberculosis in KwaZulu-Natal, South Africa, 2000–2003. Int J Tuberc Lung Dis 2010;14:413-9.
14. Gler MT, Podewils LJ, Munez N, Galipot M, Quelapio MID, et al. (2012) Impact of patient and program factors on default during treatment of multidrug-resistant tuberculosis. Int J TB Lung Dis 16(7): 955–960. doi:10.5588/ijtld.11.0502.
15.Tupasi TE, Garfin AM, Kurbatova EV, Mangan JM, Orillaza-Chi R, Naval LC,Balane GI, Basilio R, Golubkov A, Joson ES,et al Factors Associated with Loss to Followup during Treatment for Multidrug-Resistant Tuberculosis, the Philippines, 2012-2014..Emerg Infect Dis. 2016 Mar; 22(3):491-502
16. Lalor MK, Greig J, Allamuratova S, Althomsons S, Tigay Z, et al. (2013) Risk Factors Associated with Default from Multiand Extensively Drug-Resistant Tuberculosis Treatment, Uzbekistan: A Retrospective Cohort Analysis. PLoS ONE 8(11): e78364. doi:10.1371/journal.pone.0078364
17. Jeon DS, Shin DO, Park SK, Seo JE, Seo HS, Cho YS, et al. Treatment outcome and mortality among patients with multidrugresistant tuberculosis in tuberculosis hospitals of the public sector. J Korean Med Sci 2011;26:33e41.
18. Jain K, Desai M, Solanki R, Dikshit RK. Treatment outcome of standardized regimen in patients with multidrug resistant tuberculosis. J Pharmacol Pharmacother 2014;5:145e9.
19. Duraisamy K, Mrithyunjayan S, Ghosh S, Nair SA, Balakrishnan S, Subramoniapillai J, et al. Does alcohol consumption during multidrug-resistant tuberculosis treatment affect outcome? A population-based study in Kerala, India. Ann Am Thorac Soc 2014;11:712e8.
20. Chiang, Centis R, Migliori GB. Invited Review Series: Drug-Resistant tuberculosis: Past, present, future. Respirology. 2010; 15: 413–432. doi: 10.1111/j.1440-1843.2010.01738.x PMID: 20337989.
21. Cavanaugh JS, Kazennyy BY, Nguyen ML, Kiryanova E V, Vitek E, Khorosheva TM, et al. Outcomes and follow-up of patients treated for multidrug-resistant tuberculosis in Orel, Russia, 2002–2005. Int J Tuberc Lung Dis. 2012; 16: 1069–74. doi:10.5588/ijtld.11.0696 PMID: 22691694.
IssueVol 6 No 3 (2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jbe.v6i3.5099
Multidrug Resistance tuberculosis Lost to follow up Risk Factors Punjab Logistic regression model

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Kanwal S, Akhtar A. Risk Factors Associated with Lost to Follow up Among Multidrug Resistance Tuberculosis Patients Registered for Treatment in Programmatic Management of Drug Resistant Tuberculosis Sites of Punjab, Pakistan. jbe. 6(3):162-169.