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A qualitative exploration of tuberculosis patients who were lost to follow-up in Malaysia

Tok PSK 1 , Wong LP 2 , Liew SM 3 , Razali A 4 , Mahmood MI 4 , Chinnayah T 4 Show all authors , Kawatsu L 5 , Toha HR 6 , Mohd Yusof K 6 , Abd Rahman R 7 , Che Mat Din SNA 6 , Loganathan T 2

Affiliations 

  • 1 Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
  • 2 Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 3 Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 4 Sector of TB/Leprosy, Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
  • 5 Department of Epidemiology and Clinical Research, the Research Institute of Tuberculosis, Japan Anti-tuberculosis Association (RIT/JATA), Tokyo, Japan
  • 6 Johor State Health Department, Ministry of Health Malaysia, Johor Bahru, Johor, Malaysia
  • 7 Respiratory Medicine Department, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor, Malaysia
PLoS One, 2023;18(9):e0289222.
PMID: 37676902 DOI: 10.1371/journal.pone.0289222

Abstract

BACKGROUND: Loss to follow-up (LTFU) is an unsuccessful treatment outcome for tuberculosis (TB) patients. In Malaysia, LTFU affects around 1 in 20 TB patients. Integration of qualitative research methods and evidence will provide a better understanding of LTFU and its underlying issues. In this study, we qualitatively explored TB patients' experiences in receiving treatment and their reasons for leaving TB care.

METHOD: In-depth interviews of 15 patients with a history of LTFU were conducted from January to September 2020. Interview guides were developed to explore TB patients' experiences while receiving treatment, including challenges faced and reasons for treatment interruption. Data were thematically analysed using the framework method.

RESULTS: We identified 11 emerging themes that occurred at four levels of interaction with TB patients. First, at the patient personal level, TB beliefs referring to patients' perception of illness and wellness, patients' perceived role of traditional and complementary medicine, and substance abuse were important. Second, the healthcare system and treatment factors that were highlighted included the organisation of care and treatment, interaction with healthcare professionals, particularly in communication and counselling, and TB medications' side effects. Third, structural factors including financial burden, logistical and transportation issues and work-related factors were identified to be barriers to treatment continuation. Fourth, the interpersonal level interaction of patients should not be neglected; this includes family relationships and support as well as peer influence.

CONCLUSION: Study findings put forth issues and challenges faced by TB patients while receiving treatment and underscore areas where actions can be taken. This will contribute to informing the development and implementation of future TB control strategies that are responsive to TB patients' needs and concerns, to effectively address LTFU and ensure better treatment completion rates among TB patients in Malaysia.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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