Influence of Decentralization and Type of patient on Lost to follow-up in Multidrug-Resistant Tuberculosis Patients in Indonesia 2014-2015: A Survival Analysis
Drug resistant TB patients had a greater risk of LTFU than drug-sensitive TB patients due to longer treatment duration. The aims of this study were to determine the influence of decentralization and type of patient to LTFU in MDR-TB patients in Indonesia. This study was conducted in May-June 2018 at Sub Directorate of TB - Ministry of Health of the Republic of Indonesia. The study design was retrospective cohort. Samples were taken in total sampling with a total of 961 patients. 86.3% of patients were decentralized. Based on the type, the patient consists of 35.17% relapse, 5.52% new, 13.94% after LTFU, 23.10% failure category 1, 20.29% failure category 2, 1.9 % other patients. In multivariate analysis revealed that decentralization reduced the probability of LTFU up to 46% (HR 0.54, 95% CI 0.35-0.84). For patient type, treatment after LTFU, failure category 2 and others increased the probability of LTFU by 50% (HR 2,02; 95% CI 1,18-3,45), 53% (HR 2,13; 95% CI 1,24-3,66), and 74% (HR 3,80; 95% CI 1,54-9,36) consecutively compared with the type of relapse patients (baseline). Health workers were suggested to spend more time in communicating, informing and educating about TB treatment and the benefits of decentralization to MDR-TB patients. Moreover, it is suggested to conduct patient type screening in the beginning of the treatment to be able to identify the risk of LTFU.
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