Tuberculosis patients in primary care do not start treatment. What role do health system delays play?

Int J Tuberc Lung Dis. 2013 May;17(5):603-7. doi: 10.5588/ijtld.12.0505.


Setting: Primary health care facilities in five provinces of South Africa.

Objective: To investigate the association between the proportion of sputum results with a prolonged smear turnaround time and the proportion of smear-positive tuberculosis (TB) cases initially lost to follow-up.

Design: The unit of investigation was a primary health care facility and the outcome was the initial loss to follow-up rate per facility, which was calculated by comparing the sputum register with the TB treatment register. A prolonged turnaround time was defined as more than 48 h from when the sputum sample was documented in the sputum register to receipt of the result at the facility.

Results: The mean initial loss to follow-up rate was 25% (95%CI 22-28). Smear turnaround time overall was inversely associated with initial loss to follow-up (P = 0.008), when comparing Category 2 (33-66% turnaround time within 48 h) with Category 1 (0-32%) (OR 0.73, 95%CI 0.48-1.13, P = 0.163) and when comparing Category 3 (67-100%) with Category 1 (OR 0.62, 95%CI 0.39-0.99, P = 0.045). The population preventable fraction of initial loss to follow-up (when turnaround time was <48 h in ≥67% of smear results) was 21%.

Conclusion: Initial loss to follow-up should be reported as part of the TB programme to ensure that patients are initiated on treatment to prevent transmission within communities.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Antitubercular Agents / therapeutic use*
  • Bacteriological Techniques
  • Humans
  • Multivariate Analysis
  • Mycobacterium tuberculosis / isolation & purification
  • Odds Ratio
  • Predictive Value of Tests
  • Primary Health Care*
  • Registries
  • Risk Factors
  • South Africa
  • Sputum / microbiology
  • Time Factors
  • Time-to-Treatment*
  • Treatment Outcome
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / drug therapy*
  • Tuberculosis, Pulmonary / microbiology
  • Tuberculosis, Pulmonary / transmission


  • Antitubercular Agents