Characteristics, survival times and prognostic factors of tb loss to follow up (LTFU) in Malaysia – a 5-year retrospective cohort from 2014 to 2018

The increasing prevalence of tuberculosis (TB) loss to follow-up (LTFU) remains a significant challenge in Malaysia's TB control efforts. TB patients who become LTFU contribute to prolonged disease transmission, increased drug resistance, and higher healthcare costs. This study aims to determine the prevalence, characteristics, and prognostic factors of TB LTFU in Malaysia from 2014 to 2018, using data from the MyTB (National TB Registration). It also investigates the mean/median time to LTFU to identify critical periods for targeted interventions. A retrospective cohort study was conducted on the 97,542 selected samples, focusing on sociodemographic, treatment duration, comorbidity, and treatment-related factors. Kaplan-Meier methods were applied to assess the survival times (time-to-event) and risk of LTFU among different patient groups. Cox Proportional Hazard analysis was applied to determine the prognostic factors of TB LTFU. The findings reveal that the highest LTFU rates occurred among previously treated TB patients and those with comorbidities, such as HIV. Overall TB LTFU prevalence was 6.7%, with yearly prevalence reduce from 7.09% to 5.71%. The median time to LTFU was within the continuation phase of treatment, emphasizing the importance of sustained follow-up during this period. Prognostic factors identified include age, gender, nationality, ethnicity, residential area, education, employment status, DM, HIV, smoking, treatment place, TB anatomical location, TB category, healthcare worker status, chest x-ray severity, and DOT status. Further subgroup analysis shows changes of prognostic factors behaviour when stratified by DOT status. These results underscore the need for a holistic and strategic approach to TB management, including enhanced adherence counselling, patient education, and resource allocation for high-risk groups. This study aligns with Malaysia’s National Strategic Plan to End TB and the global targets for TB elimination by 2030, offering insights to policymakers and healthcare professionals to reduce LTFU and improve TB treatment outcomes.