Predictors of loss to follow-up of tuberculosis cases under the DOTS programme in Namibia

Dan Kibuule; Philomein Aiases; Nunurai Ruswa; Timothy William Rennie; Roger K Verbeeck; Brian Godman; Mwangana Mubita

doi:10.1183/23120541.00030-2019

Predictors of loss to follow-up of tuberculosis cases under the DOTS programme in Namibia

ERJ Open Res. 2020 Mar 16;6(1):00030-2019. doi: 10.1183/23120541.00030-2019. eCollection 2020 Jan.

Authors

Dan Kibuule¹, Philomein Aiases¹, Nunurai Ruswa², Timothy William Rennie¹, Roger K Verbeeck¹, Brian Godman^{3

4

5

6}, Mwangana Mubita¹

Affiliations

¹ School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia.
² National Tuberculosis and Leprosy Programme, Ministry of Health and Social Services, Windhoek, Namibia.
³ Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden.
⁴ Strathclyde Institute of Pharmacy and Biomedicial Sciences, University of Strathclyde, Glasgow, UK.
⁵ Dept of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa.
⁶ Health Economics Centre, University of Liverpool Management School, Liverpool, UK.

Abstract

Background: In Namibia, one out of every 25 cases of tuberculosis (TB) is "lost to follow-up" (LTFU). This has impacted negatively on national efforts to end the disease by 2035. The aim of this study was to determine the trends and predictors of LTFU under the directly observed treatment short-course (DOTS) programme in Namibia.

Methods: The study involved a retrospective longitudinal analysis of a nationwide cohort of TB cases registered under the DOTS programme in Namibia from 2006 to 2015. The trends and predictors of LTFU among cases in the National Electronic TB Register of the National TB and Leprosy Program were respectively determined by interrupted time series and multivariate logistic regression analyses using R-Studio software.

Results: Out of 104 203 TB cases, 3775 (3.6%) were LTFU. A quarter (26%) of cases with poor outcomes were due to LTFU. The annual decline in cases of LTFU was significant between the first (2005-2010) and second (2010-2015) medium-term plan period for TB programme implementation (p=0.002). The independent predictors of LTFU were male sex (p=0.004), 15-24 years age group (p=0.03), provider of treatment (p<0.001), intensive phase (p=0.047) and living in border/transit regions (p<0.001). HIV co-infection and TB regimen were not significant predictors of LTFU.

Conclusions: There were declining trends in LTFU in Namibia. DOTS programmes should integrate socioeconomic interventions for young and middle-aged adult male TB cases to reduce LTFU.