The objectives of this study were to report on pre-treatment loss to follow-up rates over a 10-year period (2001–2010) and to examine if patients' age, sex and geographic origin are associated with the observed shortcomings in the health services for all tuberculosis (TB) diagnostic and treatment centres in Fiji. It used a retrospective review of routine programme data reconciling TB laboratory and treatment registers. The results showed that a total of 690 sputum smear-positive TB patients were diagnosed in the laboratory, of whom 579 (84%) were started on anti-tuberculosis treatment - an overall pre-treatment loss to follow-up of 111 (16%). Peak loss to follow-up rates were seen in 2003, 2004 and 2010. Pre-treatment losses were all aged ≥15 years. In the Western Division of Fiji, 33% of sputum-positive patients were declared pre-treatment loss to follow-up; this division had over five times the risk of such an adverse outcome compared to the Central Division (OR 5.2, 95% CI 3.1–8.9, P less than 0.0001). The study has identified an important shortcoming in programme linkage, communication and feedback between TB diagnostic and treatment services, leading to high pre-treatment loss to follow-up rates. This negatively influences TB services, and ways to rectify this situation are discussed.
Ram, S.; Kishore, K.; Batio, I.; Bissell, K.; Zachariah, R.; Satyanarayana, S.; Harries, A.D. Pre-treatment loss to follow-up among smear-positive pulmonary tuberculosis cases: a 10-year audit of national data from Fiji. Public Health Action (2012) 2 (4) 138-141.