The Impact of Directly Observed Therapy for Tuberculosis on Loss to follow-up in Baltimore City
Olugbenga O. Obasanjo, Timothy Shields, William Coggin, Richard E. Chaisson, Gregory E. Glass

Abstract
We studied factors associated with loss-to-follow-up (LTFU) of reported cases of tuberculosis (TB) in Baltimore City from 1971 through 1995 to identify patterns in LTFU among individuals treated for TB in the city during this time. We also analyzed the spatial clustering of LTFUs to those who completed treatment. Demographic characteristics of individuals with confirmed TB were extracted from the records of the Baltimore City Health Dept. (BCHD) for every third year starting from 1971. Information on age, sex, race, ethnicity, place of birth, occupation, clinical status and place of residence were recorded. LTFUs represented a significantly higher proportion of individuals with TB prior to DOT (10.9%) than after DOT (4.7%) (p<0.0001). However, there were no differences in any of the demographic characteristics in LTFUs when compared to those who completed therapy for any of the years analyzed, except in 1992 when LTFUs were significantly younger. There were also no temporal patterns among LTFs. There was also no spatial clustering of the residences of LTFU relative to those completing therapy. We conclude that in Baltimore, DOT has successfully reduced the number of TB cases and has not resulted in an increase in or clustering of LTFU among any risk groups or geographical areas.

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