Risk Factors for Non-completion of the Cascade Medical Care for Homeless People Infected with Tuberculosis

The objective: to estimate the proportion of those lost to follow-up at individual stages of the cascade medical care for tuberculosis infection, to identify factors influencing these losses.

Subjects and Methods. A total of 810 homeless individuals were included in the prospective cohort study from January 1, 2019 to December 31, 2022. When active tuberculosis (TB) was ruled out and indications for preventive anti-tuberculosis therapy (PTBT) were established, the optimal regimen for the patient was suggested. After completion of preventive anti-tuberculosis therapy, follow-up of patients continued for at least 12 months. By the end of follow-up, patients underwent control chest X-ray to detect tuberculosis manifestations.

Results. Of the 810 people included in the study, 207 (25.6%) received preventive treatment of tuberculosis. Of them, 77/207 (37.2%) did not start a course of preventive treatment (loss to follow-up). The age of 28-37 years, alcohol addiction, and positive HIV status were associated with the biggest loss at this stage. Of the 130 people who started preventive treatment, 42 (32.3%) did not complete the full course of treatment. However, the chances of incomplete treatment on regimens of three months or longer were 5.4 (CI: 2.2-15.4) times higher versus a one-month regimen. The biggest loss of 64/88 (72.7%) cases was recorded during the follow-up period (after completion of preventive treatment). No tuberculosis cases were detected among those who received the full course of preventive treatment. While among those who refused or interrupted preventive therapy, 3 cases of tuberculosis were diagnosed. 

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