Challenges of loss to follow-up in tuberculosis research.
BACKGROUND
In studies evaluating methods for diagnosing tuberculosis (TB), follow-up to verify the presence or absence of active TB is crucial and high dropout rates may significantly affect the validity of the results. In a study assessing the diagnostic performance of the QuantiFERON®-TB Gold In-Tube test in TB suspect children in Tanzania, factors influencing patient adherence to attend follow-up examinations and reasons for not attending were examined.


METHODS
In 160 children who attended and 102 children who did not attend scheduled 2-month follow-up baseline health characteristics, demographic data and risk factors for not attending follow-up were determined. Qualitative interviews were used to understand patient and caretakers reasons for not returning for scheduled follow-up.


RESULTS
Being treated for active tb in the dots program (OR: 4.14; 95% CI:1.99-8.62;p-value<0.001) and receiving money for the bus fare (OR:129; 95% CI 16->100;P-value<0.001) were positive predictors for attending follow-up at 2 months, and 21/85(25%) of children not attending scheduled follow-up had died. Interviews revealed that limited financial resources, i.e. lack of money for transportation and poor communication, were related to non-adherence.


CONCLUSIONS
Patients lost to follow-up is a potential problem for TB research. Receiving money for transportation to the hospital and communication is crucial for adherence to follow-up conducted at a study facility. Strategies to ensure follow-up should be part of any study protocol.
Clinical Research Unit, Hvidovre Hospital, Hvidovre, Denmark. tnnissen@gmail.com
Thomas N
TN
Nissen
Michala V
MV
Rose
Godfather
G
Kimaro
Ib C
IC
Bygbjerg
Sayoki G
SG
Mfinanga
Pernille
P
Ravn
D035843:Biomedical Research; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D003142:Communication; D005260:Female; D005500:Follow-Up Studies; D006262:Health; D006801:Humans; D007223:Infant; D059012:Lost to Follow-Up; D008297:Male; D013636:Tanzania / Q000453:epidemiology; D014376:Tuberculosis / Q000191:economics / Q000453:epidemiology*