Losses to follow-up during tuberculosis treatment, Bogotá, Colombia, 2016–2022

Abstract

Introduction: Tuberculosis elimination remains a global priority (1). However, loss to follow-up threatens the success of control programs, as it leads to increased morbidity and mortality rates, as well as the emergence of drug resistance. The objectives of this study were to describe the social determinants associated with loss to follow-up in the tuberculosis program.

Population and Methods: Records of drug-susceptible tuberculosis cases from the district program (2016–2022) were analyzed using descriptive statistics, chi-square tests (difference in proportions), and relative risk (RR) with 95% confidence intervals (CI).

Results: Loss to follow-up was observed with a male-to-female ratio of 2, predominantly among adults (RR: 3.2; 95% CI: 2.59–3.96) and individuals belonging to ethnic minorities (4.8%). Among special population groups, homeless individuals stood out (RR: 6.8; 95% CI: 5.95–7.84). Lack of health system affiliation was also a major factor (RR: 5.0; 95% CI: 4.11–6.11), as well as psychoactive substance use (RR: 5.7; 95% CI: 4.55–7.20). The most relevant comorbidities were HIV (32.4%), malnutrition (22%), and mental illness (0.5%). A previous history of loss to follow-up (RR: 6.1; 95% CI: 5.10–7.45) was a critical finding, along with place of residence (RR: 5.1; 95% CI: 3.88–6.95).

Conclusions: Loss to follow-up for tuberculosis in Bogotá D.C. is associated with social determinants that reflect the socioeconomic vulnerability of patients. Therefore, public health interventions must be comprehensive and tailored