Missed appointments among rifampicin-resistant tuberculosis (RR-TB) patients at a decentralised RR-TB outpatient clinic in Johannesburg, South Africa

Renu Gajee, Kathryn Schnippel, Nompumelelo Mthupha, Batanayi Muzah, Rebecca Berhanu


Background. With the implementation of outpatient (ambulatory) decentralised rifampicin-resistant tuberculosis (RR-TB) treatment in South Africa (SA) since late 2011, the high rates of loss from treatment are a significant concern. Missed appointments lead to treatment interruptions and may contribute to amplification of resistance, ongoing transmission of RR-TB and an increased risk of morbidity and mortality to the patient.

Objective. To describe characteristics of patients who missed scheduled appointments during ambulatory RR-TB treatment.

Methods. The study was a retrospective, deidentified electronic medical record review of RR-TB patients at an outpatient clinic in Johannesburg, SA, from March 2013 to December 2014. Associations between missed appointments and clinical and demographic characteristics were analysed using time-to-event Cox proportional hazards regression.

Results. Of 172 patients who met the eligibility criteria, 53.5% missed at least one appointment and 39.5% missed three or more. More than half (59.8%) of first missed appointments occurred within the first 3 months after treatment initiation. The median number of days from initiation until the first missed appointment was 82 (interquartile range 52 - 260.5). HIV-infected patients with a CD4 count of ≤100 cells/µL (adjusted hazard ratio (aHR) 4.25, 95% confidence interval (CI) 1.49 - 12.18), patients referred from an inpatient facility (aHR 1.96, 95% CI 1.18 - 3.25) and patients aged 18 - 24 years as opposed to those aged 35 - 44 years (aHR 3.26, 95% CI 1.20 - 8.84) were all more likely to miss one or more appointments.

Conclusion. HIV-infected patients with a low CD4 count, patients referred from inpatient care and young patients are at high risk of missing appointments and should receive interventions targeted at improving retention.

Authors' affiliations

Renu Gajee, Right to Care, Johannesburg, South Africa

Kathryn Schnippel, Right to Care, Johannesburg, South Africa; Clinical HIV Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Nompumelelo Mthupha, Right to Care, Johannesburg, South Africa

Batanayi Muzah, Right to Care, Johannesburg, South Africa

Rebecca Berhanu, Right to Care, Johannesburg, South Africa; School of Medicine, University of North Carolina, Chapel Hill, USA

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Treatment adherence; Drug-resistant tuberculosis; Rifampicin-resistant tuberculosis; Loss from treatment

Cite this article

South African Medical Journal 2016;106(9):912-917. DOI:10.7196/SAMJ.2016.v106i9.10570

Article History

Date submitted: 2016-01-22
Date published: 2016-08-07

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