title: Follow-up and tracing of tuberculosis patients who fail to attend their scheduled appointments in Cotonou, Benin: a retrospective cohort study.
abstract: BACKGROUND
  In the "Centre National Hospitalier de Pneumo-Phtisiologie" of Cotonou, Benin, little is known about the characteristics of patients who have not attended their scheduled appointment, the results of tracing and the possible benefits on improving treatment outcomes. This study aimed to determine the contribution of tracing activities for those who missed scheduled appointments towards a successful treatment outcome.
  
  
  METHODS
  A retrospective cohort study was carried out among all smear-positive pulmonary tuberculosis patients treated between January and September 2013. Data on demographic and diagnostic characteristics and treatment outcomes were accessed from tuberculosis registers and treatment cards. Information on those who missed their scheduled appointments was collected from the tracing tuberculosis register. A univariate analysis was performed to explore factors associated with missing a scheduled appointment.
  
  
  RESULTS
  Of 457 patients (410 new smear-positive and 47 retreatment tuberculosis), 37 (8%) missed one or more of their appointments with a total of 44 episodes of missed appointments. The 3.5th (32%) and 5th (43%) month appointments were the ones most likely to be missed. Being male was associated with a higher risk of missing appointments (RR = 4.2; 95% CI = 1.5-11.8, p = 0.004) while having HIV infection was associated with a lower risk (RR = 0.3, 95% CI = 0.1-0.9, p = 0.03). Principal reasons for missed appointments were travelling outside Cotonou (34%) and feeling better (21%). In 24 (55%) of these 44 episodes of missed appointments, contact was made with the patient who returned to the programme. These follow-up activities increased the treatment success by 4%.
  
  
  CONCLUSIONS
  In Cotonou, Benin, less than 10% of tuberculosis patients miss at least one of their scheduled appointments. Tracing activities increase the treatment success rate by 4% and current on-going practices in the Programme need to be endorsed and encouraged.
authors.affiliation: National Tuberculosis Programme, Cotonou, Benin. adeserg@yahoo.fr.|Faculté de Médecine, Université de Parakou, Parakou, Benin. adeserg@yahoo.fr.|International Union against Tuberculosis and Lung Disease, Paris, France. adeserg@yahoo.fr.
authors.forename: Serge
authors.initials: S
authors.lastname: Ade
authors.affiliation: International Union against Tuberculosis and Lung Disease, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Trébucq
authors.affiliation: International Union against Tuberculosis and Lung Disease, Paris, France.|London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: National Tuberculosis Programme, Cotonou, Benin.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Ade
authors.affiliation: National Tuberculosis Programme, Cotonou, Benin.
authors.forename: Gildas
authors.initials: G
authors.lastname: Agodokpessi
authors.affiliation: National Tuberculosis Programme, Cotonou, Benin.
authors.forename: Prudence
authors.initials: P
authors.lastname: Wachinou
authors.affiliation: National Tuberculosis Programme, Cotonou, Benin.
authors.forename: Dissou
authors.initials: D
authors.lastname: Affolabi
authors.affiliation: National Tuberculosis Programme, Cotonou, Benin.
authors.forename: Sévérin
authors.initials: S
authors.lastname: Anagonou
mesh_terms: D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D001541:Benin / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data*; D019233:Retreatment / Q000523:psychology / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology