title: Pre-treatment loss to follow-up among smear-positive pulmonary tuberculosis cases: a 10-year audit of national data from Fiji.
abstract: METHODS
  All tuberculosis (TB) diagnostic and treatment centres in Fiji.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  A retrospective review of routine programme data reconciling TB laboratory and treatment registers.
  
  
  RESULTS
  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 < 0.0001).
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: Fiji National University, Suva, Fiji.
authors.forename: S
authors.initials: S
authors.lastname: Ram
authors.affiliation: Fiji National University, Suva, Fiji.
authors.forename: K
authors.initials: K
authors.lastname: Kishore
authors.affiliation: Fiji National Tuberculosis Programme, Suva, Fiji.
authors.forename: I
authors.initials: I
authors.lastname: Batio
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: K
authors.initials: K
authors.lastname: Bissell
authors.affiliation: Médecins Sans Frontières (MSF)-Operational Centre Brussels, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Satyanarayana
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
keywords: Fiji; laboratory register; operational research; pre-treatment loss to follow-up; tuberculosis