Understanding pretreatment loss to follow-up of tuberculosis patients
An explanatory qualitative study in Chennai, India
Bibliographic Data
Introduction: Pretreatment loss to follow-up (PTLFU)-dropout of patients after diagnosis but before treatment registration-is a major gap in tuberculosis (TB) care in India and globally. Patient and healthcare worker (HCW) perspectives are critical for developing interventions to reduce PTLFU. Methods: We tracked smear-positive TB patients diagnosed via sputum microscopy from 22 diagnostic centres in Chennai, one of India's largest cities. Patients who did not start therapy within 14 days, or who died or were lost to follow-up before official treatment registration, were classified as PTLFU cases. We conducted qualitative interviews with trackable patients, or family members of patients who had died. We conducted focus group discussions (FGDs) with HCWs involved in TB care. Interview and FGD transcripts were coded and analysed with Dedoose software to identify key themes. We created categories into which themes clustered and identified relationships among thematic categories to develop an explanatory model for PTLFU. Results: We conducted six FGDs comprising 53 HCWs and 33 individual patient or family member interviews. Themes clustered into five categories. Examining relationships among categories revealed two pathways leading to PTLFU as part of an explanatory model. In the first pathway, administrative and organisational health system barriers-including the complexity of navigating the system, healthcare worker absenteeism and infrastructure failures-resulted in patients feeling frustration or resignation, leading to disengagement from care. In turn, HCWs faced work constraints that contributed to many of these health system barriers for patients. In the second pathway, negative HCW attitudes and behaviours contributed to patients distrusting the health system, resulting in refusal of care. Conclusion: Health system barriers contribute to PTLFU directly and by amplifying patient-related challenges to engaging in care. Interventions should focus on removing administrative hurdles patients face in the health system, improving quality of the HCW-patient interaction and alleviating constraints preventing HCWs from providing patient-centred care
Absenteeism · Disengagement theory · Explanatory model · Family medicine · Feeling · Focus group · Health care · Pathology · Psychological intervention · Public health · Qualitative research · Thematic analysis · Tuberculosis · Diagnosis and treatment of tuberculosis · HIV/AIDS Research and Interventions · Medicine · Nursing · Psychology · Social Psychology · Tuberculosis Research and Epidemiology · Gerontology
Patient Adherence to Tuberculosis Treatment
Best Practices for Mixed Methods Research in Health Sciences
WHO's new End TB Strategy
Methods for the thematic synthesis of qualitative research in systematic reviews
High-quality health systems in the Sustainable Development Goals era
Meta-Ethnography
‘M-TRACK’ (mobile phone reminders and electronic tracking tool) cuts the risk of pre-treatment loss to follow-up by 80% among people living with HIV under programme settings
Patients pathways to tuberculosis diagnosis and treatment in a fragmented health system
Why do people living with HIV not initiate treatment? A systematic review of qualitative evidence from low- and middle-income countries
| Citations per year | 0.6 |
|---|---|
| Citation span | 2021 - 2025 (5) |
| Highly cited | No |