Early identification of individuals at risk for loss to follow-up of tuberculosis treatment: a generalised hierarchical analysis

Shirley Verônica Melo Almeida Lima, Karina Conceição Gomes Machado de Araújo, Marco Antonio Prado Nunes, Carla Nunes

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We characterise the loss to follow-up (locally termed abandoned) of tuberculosis treatment with individual and ecological health determinants and to identify the predictive capacity of these risk factors. Methods: A cohort study with individual and ecological characterisation of patients diagnosed with tuberculosis in Sergipe/Brazil from 2015 to 2018 with either loss to follow-up or completion of treatment as a therapeutic outcome was performed. The examined variables were based on the social determinants of health with descriptive analysis, binary logistic regression, a generalised hierarchical model and graphical presentation using a nomogram. Results: The loss to follow-up accounted for 18.21% of the 2,449 studied cases. The characteristics revealed that the highest abandonment percentages were people who: were male (20.0%), had black skin colour (20.3%), were aged 20–39 years (21.8%), had 4–7 years of schooling (23.6%), re-entered treatment after abandonment (36.5%), used alcohol (31.0%), used drugs (39.3%), were smokers (26.5%) and were homeless (55.4%). The ecological characteristics showed that individuals living in municipalities with a high human development index (HDI; odds ratio [OR]: 1.91) and high-income inequality (OR: 1.81) had a greater chance of not finishing the treatment. Most of these variables were identified as predictors in the generalised hierarchical model; the receiver operating characteristic curve (ROC) curve had 0.771 precision and 84.0% accuracy. Conclusion: The group of identified characteristics influenced the loss to follow-up of tuberculosis treatment. This data provides evidence for the early identification of individuals who are at greater risk of abandoning tuberculosis treatment.

Original languageEnglish
Article numbere06788
JournalHeliyon
Volume7
Issue number4
DOIs
Publication statusPublished - Apr 2021

Keywords

  • Epidemiology
  • Risk factors
  • Social determinants of health
  • Therapy
  • Tuberculosis

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