Pretreatment loss to follow-up of bacteriologically confirmed TB patients in early

implementation of centralized rapid molecular testing: A preliminary cost-effectiveness

study on the decentralized model.

Ratno Widoyo1, Defriman Djafri 1, Ade Suzana Eka Putri 1

1
Department of Epidemiology and Biostatistics, Faculty of Public Health, Universitas Andalas, Padang 25128,
Indonesia.

Abstract

Background and Aims:

Our previous study found that the percentage of pretreatment loss-to-follow-up of
bacteriologically confirmed TB patients diagnosed in hospitals was higher than those diagnosed
in primary healthcare. This study aims to identify the loss among the centralized algorithm for
those whose sputum samples were collected in primary healthcare centers and bacteriologically
tested in hospitals.

Methods:
The study was conducted in 2019 at district and provincial hospitals with a rapid molecular test
known as "tes cepat molekuler" (TCM) in West Sumatra province. A subset of the laboratory
register in the year 2018 was used. We traced these patients using demographic pair matching
and Jaro-Winkler string distance to determine whether the bacteriologically confirmed patients
were treated.

Results:
A total of 494 records were traced, of which 125 (25.5%) were not found in the provincial
treatment register. The percentage of pretreatment loss to follow-up was higher among the
elderly, females, those with a residential address in the city, and those with a sputum test
performed in the district hospital. We assume that this problem was caused by the newly
implemented centralized TCM method. The turnaround time delay and the need for revisits to
primary health care might have contributed to this issue.

Conclusion:
In conclusion, we will analyze the possibility of decentralizing TCM to primary health care,
where these facilities serve as the backbone of tuberculosis case finding and care. The
incremental cost of the total DALYs averted will be calculated to determine the cost-
effectiveness of this model.

Keywords: TCM, molecular test, preliminary cost-effectiveness, Indonesia