Peter Seah Keng Tok1, Tharani Loganathan2, Li Ping Wong2, Su May Liew2, Asmah Razali3, Thilaka Chinnayah3, Shaharom Nor Azian Che Mat Din4
1Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
2University of Malaya, Kuala Lumpur, Malaysia
3TB/Leprosy Sector, Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
4Johor State Health Department, Ministry of Health Malaysia, Johor, Malaysia
Introduction
In Malaysia, LTFU comprises approximately a quarter of all unsuccessful treatment outcomes among TB patients. Evidence on LTFU determinants in the local context is important for the evaluation of the national TB control programme.
Objective
To investigate the determinants of LTFU among TB patients in Malaysia, including patient reasons for leaving care.
Methodology
A retrospective cohort study was conducted using the national TB surveillance data from 2014 until 2017 to investigate for potential association between socio-demographic and TB disease variables with LTFU among TB patients using logistic regression analysis. Additionally, a qualitative study was conducted in Johor in 2020 to explore reasons for leaving TB treatment among TB patients with a history of LTFU. A total of 15 in-depth interviews were conducted.
Result
From the total of 97,505 TB cases analysed, 5.3% (n=5,161) had LTFU. LTFU was significantly associated with younger age, male sex, Malaysians, urban residence, lower education levels, no diabetes mellitus, smoking, previous treatment for TB, smear-positive TB, and human immunodeficiency virus co-infection. In the qualitative study, a total of 11 emerging themes were identified at four levels of interaction, which included patients’ personal factors, structural factors, healthcare factors, and interpersonal or societal level factors.
Conclusion
Study findings reiterate the need for and guide the means to address LTFU among TB patients in Malaysia.