title: Tuberculosis patients in primary care do not start treatment. What role do health system delays play?
abstract: METHODS
  Primary health care facilities in five provinces of South Africa.
  
  
  OBJECTIVE
  To investigate the association between the proportion of sputum results with a prolonged smear turnaround time and the proportion of smear-positive tuberculosis (TB) cases initially lost to follow-up.
  
  
  METHODS
  The unit of investigation was a primary health care facility and the outcome was the initial loss to follow-up rate per facility, which was calculated by comparing the sputum register with the TB treatment register. A prolonged turnaround time was defined as more than 48 h from when the sputum sample was documented in the sputum register to receipt of the result at the facility.
  
  
  RESULTS
  The mean initial loss to follow-up rate was 25% (95%CI 22-28). Smear turnaround time overall was inversely associated with initial loss to follow-up (P = 0.008), when comparing Category 2 (33-66% turnaround time within 48 h) with Category 1 (0-32%) (OR 0.73, 95%CI 0.48-1.13, P = 0.163) and when comparing Category 3 (67-100%) with Category 1 (OR 0.62, 95%CI 0.39-0.99, P = 0.045). The population preventable fraction of initial loss to follow-up (when turnaround time was <48 h in ≥67% of smear results) was 21%.
  
  
  CONCLUSIONS
  Initial loss to follow-up should be reported as part of the TB programme to ensure that patients are initiated on treatment to prevent transmission within communities.
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa. mcla@sun.ac.za
authors.forename: M M
authors.initials: MM
authors.lastname: Claassens
authors.forename: E
authors.initials: E
authors.lastname: du Toit
authors.forename: R
authors.initials: R
authors.lastname: Dunbar
authors.forename: C
authors.initials: C
authors.lastname: Lombard
authors.forename: D A
authors.initials: DA
authors.lastname: Enarson
authors.forename: N
authors.initials: N
authors.lastname: Beyers
authors.forename: M W
authors.initials: MW
authors.lastname: Borgdorff
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D001431:Bacteriological Techniques; D006801:Humans; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011320:Primary Health Care; D012042:Registries; D012307:Risk Factors; D013019:South Africa; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000635:transmission
chemical_list: D000995:Antitubercular Agents