Risk Factor of Lost to Follow-up Treatment in drug-sensitive pulmonary TB patients
DOI:
https://doi.org/10.51601/ijhp.v5i4.468Abstract
Background: Loss to follow-up (LTFU) treatment remains a critical challenge in tuberculosis control in Indonesia, accounting for approximately 50% of treatment failure cases among pulmonary TB patients. Objectives: To identify independent predictors of LTFU among drug-sensitive TB (DS-TB) patients in Medan, Indonesia. Methods: This cross-sectional analytical study enrolled 100 DS-TB patients (40 with LTFU, 60 treatment-completed) from two hospitals. Purposive sampling technique was employed. Data were collected using validated questionnaires assessing sociodemographic characteristics, patient perspective toward TB treatment, social support (using MSPSS scale), and healthcare services quality. Bivariate analysis used chi-square and Fisher's exact tests; multivariate analysis employed multiple logistic regression. Statistical significance was set at p < 0.05. Results: Multivariate analysis identified two independent predictors of LTFU: social support (odds ratio 128.632; 95% confidence interval 13.809 to 1,198.216; p < 0.001) and treatment perspective (odds ratio 25.415; 95% confidence interval 5.569 to 115.985; p < 0.001). Low to moderate social support was the most dominant risk factor, conferring approximately 128.7 times greater odds of treatment discontinuation compared to high social support. Poor treatment perspective was the second dominant predictor, with 90% of LTFU patients demonstrating negative perspectives. Conclusion: Poor treatment perspective and low to moderate social support are significantly associated with LTFU treatment discontinuation in DS-TB patients. Psychosocial interventions addressing these factors should be prioritized in TB control programs to improve treatment completion rates and achieve WHO treatment success targets.
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Absor, S., Nurida, A., Levani, Y., & Nerly, W. S. (2020). The relationship between educational level and treatment adherence among pulmonary TB patients in Lamongan Regency from January 2016 to December 2018. Medica Arteriana, 2(2), 78-89.
Alinaitwe, B., Kasirye, P., Tumusiime, P., & et al. (2025). Level of family support and associated factors among pulmonary tuberculosis patients on first-line treatment in Jinja, Eastern Uganda: A baseline cross-sectional survey. BMJ Public Health, 2(1), e000618.
Armelia, H., & Mansur, U. (2011). Evaluasi kepatuhan berobat penderita tuberkulosis paru tahun 2010-2011 di Puskesmas Kecamatan Pancoran Mas Depok. [Evaluation of treatment adherence among pulmonary tuberculosis patients in 2010-2011 at Pancoran Mas District Health Center, Depok]. Universitas Indonesia.
Batista, J. F. C., Santos, M. A. A., & Lima, S. O. (2025). Trend of epidemiological indicators and factors associated with tuberculosis treatment dropout among homeless persons in Brazil. Revista de Saúde Pública, 34, e20240273.
Birhane, M., Mekonnen, S., Dingeta, T., & Teklemariam, Z. (2023). Loss to follow-up tuberculosis treatment and associated factors among adults attending at public health facilities in Warder District, Somali Regional State, Eastern Ethiopia. Frontiers in Public Health, 11, 1234865.
Chida, N., Ansari, Z., Hussain, H., & et al. (2015). Determinants of default from tuberculosis treatment among patients with drug-susceptible tuberculosis in Karachi, Pakistan: A mixed methods study. PLoS ONE, 10(10), e0142384.
Creswell, J. W., & Creswell, J. D. (2023). Research design: Qualitative, quantitative, and mixed methods approaches (6th ed.). SAGE Publications.
Dameria, D., Nasir, N., & Habibullah, A. (2023). Improvement of patients' knowledge, attitude, and practice on pulmonary tuberculosis with video and leaflet education. Jurnal Pendidikan Kesehatan Indonesia, 12(3), 456-469.
Emzir. (2021). Metodologi penelitian pendidikan: Kuantitatif dan kualitatif. Rajawali Pers.
Green, L. W., & Kreuter, M. W. (1991). Health promotion planning: An educational and environmental approach (2nd ed.). Mayfield Publishing.
Jiang, Y., Chen, J., Ying, M., Liu, L., Li, M., Lu, S., & et al. (2023). Factors associated with loss to follow-up before and after treatment initiation among patients with tuberculosis: A 5-year observation in China. Frontiers in Medicine, 10(April), 1-9.
Kim, H. Y. (2017). Statistical notes for clinical researchers: Chi-squared test and Fisher's exact test. Restorative Dentistry & Endodontics, 42(2), 152-155.
Kondoy, P. P. H., Rombot, D. V., Palandeng, H. M. F., & Pakasi, T. A. (2014). Faktor-faktor yang berhubungan dengan kepatuhan berobat pasien tuberkulosis paru di lima Puskesmas di Kota Manado. [Factors associated with treatment adherence among pulmonary tuberculosis patients at five public health centers in Manado City]. Jurnal Kedokteran Komunitas dan Tropis, 2(II), 1-8.
Maelani, T., & Cahyati, W. H. (2019). Characteristics of patients, medication side effects, and lost to follow-up treatment in pulmonary tuberculosis: An overview. HIGEIA: Journal of Public Health Research and Development, 3(4), 445-456.
Mangan, J. M., Tupasi, T. E., Garfin, A. M. C. G., Lofranco, V., Orillaza-Chi, R., Basilio, R., & et al. (2016). Multidrug-resistant tuberculosis patients lost to follow-up: Self-reported readiness to restart treatment. International Journal of Tuberculosis and Lung Disease, 20(9), 1145-1152.
Masita, M., & Andriani, H. (2023). A determinant analysis of loss to follow-up events in pulmonary tuberculosis patients: Literature review. Media Publikasi Promosi Kesehatan Indonesia, 6(798), 798-806.
Memona, M. A., & et al. (2025). Purposive sampling in quantitative research: A review and guidelines for rigorous implementation. Journal of Applied Sciences & Environmental Management, 29(1), 1-20.
Mirawati, N., Sukartini, T., & Qona'ah, A. (2019). Correlation between healthcare provider's attitude and patient adherence to tuberculosis treatment. Jurnal Kesehatan Indonesia, 8(4), 445-452.
Mishra, P., Sharma, R. K., Yadav, R., Rao, V. G., Nigam, S., & Lingala, M. A. (2021). Reasons for loss to follow-up (LTFU) of pulmonary TB (PTB) patients: A qualitative study among Saharia, a particularly vulnerable tribal group of Madhya Pradesh, India. PLoS ONE, 16(12), e0260832.
Mukti, B. H. (2025). Methods in health research: Probability and non-probability sampling. Health Sciences International Journal, 3(2), 220-234.
Munro, S. A., Lewin, S. A., Smith, H. J., Engel, M. E., Fretheim, A., & Volmink, J. (2007). Patient adherence to tuberculosis treatment: A systematic review of qualitative research. PLoS Medicine, 4(7), e238.
Nazhofah, Q., & Hadi, E. N. (2022). Family support and medication adherence in tuberculosis patients: A literature review. Media Publikasi Promosi Kesehatan Indonesia, 5(6), 2338.
Pandini, I., Lahdji, A., Noviasari, N. A., & Anggraini, M. T. (2022). The effect of family social support and self-esteem in improving the resilience of tuberculosis patients. Journal of Health, Education, and Welfare, 18(1), 45-56.
Pare, A. L., Amiruddin, R., & Leida, I. (2013). Hubungan antara pekerjaan, pengawas minum obat, pelayanan kesehatan, dukungan keluarga, dan diskriminasi dengan perilaku berobat pasien tuberkulosis paru pada tahun 2013. [The relationship between occupation, treatment supervisor, health services, family support, and discrimination with treatment-seeking behavior among pulmonary tuberculosis patients in 2013]. Semantic Scholar. Retrieved from https://api.semanticscholar.org/CorpusID:179163541
Rahayu, S. R., Susilastuti, M. S., Saefurrohim, M. Z., Azam, M., Indrawati, F., Supriyono, M., & et al. (2023). Lost to follow-up among tuberculosis patients during the public-private mix era in rural area of Indonesia. Ethiopian Journal of Health Sciences, 33(1), 115-122.
Soedarsono, S., Mertaniasih, N. M., Kusmiati, T., Permatasari, A., Juliasih, N. N., Hadi, C., & et al. (2021). Determinant factors for loss to follow-up in drug-resistant tuberculosis patients: The importance of psycho-social and economic aspects. BMC Pulmonary Medicine, 21(1), 336.
Soleman, R. P. H., Sukartini, T., & Qona'ah, A. (2021). Patient adherence to tuberculosis treatment: A relation between family support and patient behavior. Critical Medical and Surgical Nursing Journal, 10(2), 42-46.
Sudaryono. (2022). Metodologi penelitian. Rajawali Pers.
Sugiyono. (2021). Metode penelitian kuantitatif, kualitatif, dan R&D. Alfabeta.
Sulistyo, Utami, A., & Wicaksono, A. (2021). Laporan Program Penanggulangan Tuberkulosis Tahun 2021. [Report on the Tuberculosis Control Program for the Year 2021]. Ministry of Health Indonesia, 17.
Tola, H. H., Tol, A., Shojaeizadeh, D., & Garmaroudi, G. (2015). Tuberculosis treatment non-adherence and lost to follow up among TB patients with or without HIV in developing countries: A systematic review. Iranian Journal of Public Health, 44(3), 1-21.
Walker, I. F., Shi, O., Hicks, J. P., Elsey, H., Wei, X., Menzies, D., & et al. (2019). Analysis of loss to follow-up in 4099 multidrug-resistant pulmonary tuberculosis patients. European Respiratory Journal, 54(1), 1900505.
World Health Organization. (2023). Global tuberculosis report 2023. WHO.
Yuda, A. A. (2018). Hubungan karakteristik, pengetahuan, sikap, dan tindakan penderita tuberkulosis paru dengan kepatuhan minum obat di Puskesmas Tanah Kalikedinding. [The relationship between characteristics, knowledge, attitudes, and practices of pulmonary tuberculosis patients and medication adherence at Tanah Kalikedinding public health center]. [Thesis, Universitas Airlangga]. Retrieved from https://repository.unair.ac.id/85196/4/fulltext.pdf
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52(1), 30-41.
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