Identifying and addressing factors contributing to pretreatment loss to follow-up of tuberculosis patients referred for treatment from medical colleges in Pondicherry: An implementation research

Background: In India, there is no feedback regarding 34% of tuberculosis (TB) patients diagnosed and referred from medical colleges for treatment to peripheral health institutions (PHIs). Objectives: The aim of this study is to measure the effectiveness of the new intervention package, developed based on qualitative study in reducing pretreatment loss to follow-up (PTLFU) of all TB patients diagnosed and referred for treatment from medical colleges to PHIs. Materials and Methods: An intervention was developed based on the findings of in depth-interviews conducted among different stakeholders such as TB patients who did/did not report, service providers working in four medical colleges in Pondicherry. Intervention consisting of phone calls, home visits, etc., was implemented for a period of 6 months. The baseline and endline proportion of TB patients for whom feedback received was determined from the available records (Revised National TB Control Program State Task Force Quarterly reports). Results: Patient's ignorance, lack of faith in healthcare system, side effects and social stigma, unpleasant experience in hospitals, poor accessibility to directly observed treatment, short-course centers, drugs shortage, poor coordination between program and hospital staff were the risk factors for PTLFU. At baseline, the proportions of feedback received about TB patients referred for treatment from medical colleges to PHIs was 46%. After the initiation of interventions, it increased to 61% and 66% in the first and second quarters of 2017, respectively. Conclusion: Risk factors for PTLFU were multi-factorial related to both patient and health system. Simple, feasible interventions such as phone calls and home visits to TB patients were effective in reducing PTLFU.