Prevalence of lost to follow-up in drug-sensitive TB patients in WHO SEAR countries: A systematic review and meta-analysis

Background: Tuberculosis (TB) is a major global public health concern, particularly in the South-East Asia Region (SEAR), which accounts for 43% of worldwide TB cases. Loss to follow-up (LTFU) during treatment poses a significant obstacle to tuberculosis management, leading to treatment failure and the emergence of drug-resistant tuberculosis (DRTB).

Methods: This systematic review and meta-analysis (PROSPERO ID: CRD42024557140) sought to evaluate the prevalence of loss to follow-up (LTFU) and the associated factors among Drug-Sensitive Tuberculosis (DSTB) patients in Southeast Asian Region (SEAR) nations. A thorough literature review was conducted using the PubMed, Web of Science, and Scopus databases, concentrating on articles published from January 2013 to December 2024. A total of 130 studies were assessed, and 51 were chosen for data extraction. The Der-Simonian Laird random-effects model was employed to compute pooled prevalence. Sensitivity and subgroup analyses were employed as necessary to tackle heterogeneity.

Results: The prevalence of LTFU in DSTB was 9.1% (95% CI: 7.8-10.4%) with substantial heterogeneity (I² = 99.07%). Indonesia had highest LTFU rates (11.9%, 95% CI: 8.1-15.8%). Sensitivity analyses confirmed the robustness of our study results and while subgroup analysis highlighted the regional variation.

Conclusion: LTFU prevalence varies significantly across SEAR countries, indicating the need for context-specific interventions. Strengthening treatment adherence through patient education, financial support, and community-based initiatives is essential to bridge existing gaps and accelerate TB elimination efforts.