Long-Term Mortality and Active Tuberculosis Disease Among Patients Who Were Lost to Follow-Up During Second-Line Tuberculosis Treatment in 2011-2014: Population-Based Study in the Country of Georgia

Giorgi Kuchukhidze; Davit Baliashvili; Natalia Adamashvili; Ana Kasradze; Russell R Kempker; Matthew J Magee

doi:10.1093/ofid/ofab127

Long-Term Mortality and Active Tuberculosis Disease Among Patients Who Were Lost to Follow-Up During Second-Line Tuberculosis Treatment in 2011-2014: Population-Based Study in the Country of Georgia

Open Forum Infect Dis. 2021 Mar 15;8(6):ofab127. doi: 10.1093/ofid/ofab127. eCollection 2021 Jun.

Authors

Giorgi Kuchukhidze¹, Davit Baliashvili^{1

2}, Natalia Adamashvili¹, Ana Kasradze¹, Russell R Kempker³, Matthew J Magee⁴

Affiliations

¹ National Centre for Disease Control and Public Health, Tbilisi, Georgia.
² Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, Georgia, USA.
³ Emory University School of Medicine, Atlanta, Georgia, USA.
⁴ Hubert Department of Global Health, Emory Rollins School of Public Health, Atlanta, Georgia, USA.

Abstract

Background: High rates of loss to follow-up (LFU) exist among patients with multidrug and extensively drug-resistant tuberculosis (M/XDR TB). We aimed to identify long-term clinical outcomes of patients who were LFU during second-line TB treatment.

Methods: We conducted a follow-up study among adults who received second-line TB treatment in the country of Georgia during 2011-2014 with a final outcome of LFU. We attempted to interview all LFU patients, administered a structured questionnaire, and obtained sputum samples. Active TB at follow-up was defined by positive sputum Xpert-TB/RIF or culture.

Results: Follow-up information was obtained for 461 patients. Among these patients, 107 (23%) died and 177 (38%) were contacted. Of those contacted, 123 (69%) consented to participate and 92 provided sputum samples. Thirteen (14%) had active TB with an estimated infectious time period for transmitting drug-resistant TB in the community of 480 days (interquartile range = 803). In multivariable analysis, positive culture at the time of LFU was associated with active TB at the time of our study (adjusted risk ratio = 13.3; 95% confidence interval, 4.2-42.2).

Conclusions: Approximately one quarter of patients on second-line TB treatment who were LFU died. Among those LFU evaluated in our study, 1 in 7 remained in the community with positive sputum cultures. To reduce death and transmission of disease, additional strategies are needed to encourage patients to complete treatment.

Keywords: LFU; MDR; TB; outcomes; tuberculosis.

Abstract

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