Socioeconomic factors affecting TB loss to follow-up in Southeast Asia [TB0096]

TB loss to follow-up (LTFU) refers to patients who begin TB treatment but do not complete it or fail to attend follow-up appointments. According to the WHO, TB LTFU includes patients who stop treatment for more than eight consecutive weeks after undergoing at least four weeks of treatment. Several socioeconomic factors contribute to TB LTFU, such as low education levels, short-term migration, particularly across provinces, and lack of access to healthcare.

Community support, alcohol consumption, and smoking habits also increase the likelihood of LTFU. Men, individuals with lower incomes, and the unemployed are at higher risk of discontinuing TB treatment. Those whose household heads are self-employed tend to default more often compared to households led by government employees. Having health insurance and access to travel support reduces the risk of LTFU. Decentralizing treatment to facilities closer to patients' homes has also been shown to reduce treatment default rates.

Alcoholics demonstrate increased odds of TB loss to follow-up (LTFU), likely due to alcohol impairing judgment, reducing adherence to treatment schedules, and diminishing the effectiveness of TB medications through drug interactions. A noticeable increase in TB LTFU rates is also observed among smokers. Smoking may contribute to this through mechanisms such as the exacerbation of pulmonary symptoms, complicating the treatment process, and potentially decreasing the efficacy of TB treatment due to the harmful effects of tobacco on the respiratory system.

Migrants face unique challenges in TB treatment, resulting in a higher risk of LTFU. These challenges include unstable housing and employment, leading to inconsistent treatment adherence. The transient nature of migrants often causes treatment interruptions due to relocation and difficulties accessing consistent health care.

Additionally, individuals with health insurance are more likely to adhere to TB treatment and follow-up protocols, highlighting the significant influence of financial barriers on patient compliance. In contrast, the financial strain of out-of-pocket payments can deter individuals from seeking or continuing TB treatment, contributing to higher loss to follow-up rates among those facing substantial out-of-pocket costs.

Source: Rani, A.Y.A., Ismail, N., Zakaria, Y. and Isa, M.R., 2024. A scoping review on socioeconomic factors affecting tuberculosis loss to follow-up in Southeast Asia. Med J Malaysia, 79(4), pp.470-476. 

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