Bulletin of the World Health Organization

Pre-treatment loss to follow-up in tuberculosis patients in low- and lower-middle-income countries and high-burden countries: a systematic review and meta-analysis

Peter MacPherson, Rein MGJ Houben, Judith R Glynn, Elizabeth L Corbett & Katharina Kranzer

Volume 92, Number 2, February 2014, 126-138

Table 5. Impact of including rates of pre-treatment loss to follow-up on national tuberculosis programme indicators in hypothetical programmes in Africa and Asia with 100 000 individuals and DOTS strategy targets (70% case detection, 85% cure) theoretically achieved, 2011

Indicator Africa
Asia
Outcomes reported under current WHO targets After including tuberculosis patients lost to follow-up before treatment Outcomes reported under current WHO targets After including tuberculosis patients lost to follow-up before treatment
No. of cases 100 000 100 000 100 000 100 000
Cases detected, no. (%) 70 000 (70) 85 366a (85) 70 000 (70) 80 460a (80)
Tuberculosis patients lost to follow-up before treatment, no. (%) Unknown 15 366 (18) Unknown 10 460 (13)
Cases started on treatment, no. (%) Unknown 70 000 (82)b Unknown 70 000 (87)b
Patients cured, no. (%) 59 500 (85) 59 500 (70)c 59 500 (85) 59 500 (74)c
Deceased tuberculosis patients, no. (%) 4200d (6) 12 498e (12) 2100d (3) 3251e (3)

WHO, World Health Organization.

a Calculated as [1 ÷ (1 − fraction lost to follow-up before treatment)] × number of cases detected. For Africa: [1 ÷ 0.82] × 70 000; for Asia: [1 ÷ 0.87] × 70 000.

b Percentage calculated as number of cases initiating tuberculosis treatment divided by the number of cases detected. For Africa: 70 000 ÷ 85 366; for Asia: 70 000 ÷ 80 460.

c Percentage calculated as the number of patients who successfully completed treatment divided by the number of cases detected. For Africa: 59 500 ÷ 85 366; for Asia: 59 500 ÷ 80 460.

d Number obtained from WHO country database.

e Calculated as the number of deceased tuberculosis patients plus the product of the number of cases lost to follow-up before treatment and the median case fatality rate found in this review. For Africa: 4200 + (15 366 × 0.54); for Asia: 2100 + (10 460 × 0.11).

Note: Estimates for the western Pacific region not included, as only one study was identified.