Factors contributing to pre-treatment loss to follow-up in adults with pulmonary tuberculosis: a qualitative evidence synthesis of patient and healthcare worker perspectives

ABSTRACT

Background

Since 2018, over 14 million people have been treated for tuberculosis (TB) globally. However, pre-treatment loss to follow-up (PTLFU) has been shown to contribute substantially to patient losses in the TB care cascade with subsequent high community transmission and mortality rates.

Objective

To identify, appraise, and synthesise evidence on the perspectives of patients and healthcare workers on factors contributing to PTLFU in adults with pulmonary TB.

Methods

We registered the title with PROSPERO (CRD42021253212). We searched nine relevant databases up to 24 May 2021 for qualitative studies. Two review authors independently reviewed records for eligibility and extracted data. We assessed methodological quality with the Evidence for Policy and Practice Information Centre tool and synthesised data using the Supporting the Use of Research Evidence framework. We assessed confidence in our findings using Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual).

Results

We reviewed a total of 1239 records and included five studies, all from low- and middle-income countries. Key themes reported by patients and healthcare workers were communication challenges among healthcare workers and between healthcare workers and patients; knowledge, attitudes, and behaviours about TB and its management; accessibility and availability of facilities for TB care; and human resource and financial constraints, weakness in management and leadership in TB programmes. Patients’ change of residence, long waiting times, and poor referral systems were additional factors that contributed to patients disengaging from care. We had moderate confidence in most of our findings.

Conclusion

Findings from our qualitative evidence synthesis highlight multiple factors that contribute to PTLFU. Central to addressing these factors will be the need to strengthen health systems and offer people-centred care.

KEYWORDS:

• Tuberculosis
• pre-treatment loss to follow-up
• qualitative evidence synthesis
• healthcare system
• TB care cascade
• people-centred care

Responsible Editor Maria Emmelin

Responsible Editor Maria Emmelin

Acknowledgements

Information specialist for giving guidance on the search strategy and search. Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kisumu

Disclosure statement

No potential conflict of interest was reported by the author(s).

Contributions of authors

MM, EO, KRS, and TY contributed to the QES protocol. MM, BN, EJO, and KRS screened the studies. MM developed the data extraction tool, and all authors gave their input before the data extraction process started. MM, BN and EJO conducted data extraction. All authors gave their input on the description, appraisal, and synthesis of data. MM wrote the first draft of the manuscript and all authors contributed to the writing of the manuscript.

Ethics and consent

For this QES, a formal ethical review was not pursued since the data collected was retrospective and available to the public.

Paper context

In the tuberculosis care cascade (model used to describe healthcare delivery), pre-treatment loss to follow-up has been shown to contribute substantially to patient losses, with subsequent high community transmission and mortality. Our qualitative evidence synthesis provides comprehensive evidence on contributors to pre-treatment loss to follow-up in adults with pulmonary TB and highlights areas to intervene. To achieve optimal care, it is vital to strengthen the healthcare system and offer people-centred care.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2022.2148355

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This study is funded under the UK MRC African Research Leaders award (MR/T008768/1). This award is jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth & Development Office (FCDO) under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the European Union.” This publication is associated with the Research, Evidence and Development Initiative (READ-It) project. READ-It (project number 300342-104) is funded by UK aid from the UK government; however, the views expressed do not necessarily reflect the UK government’s official policies.”