Factors Associated with Tuberculosis Treatment Default Amongst Migrant and Mobile Populations in Myanmar

Background: Ending the global tuberculosis (TB) epidemic by 2035 will substantially depend on the effective control of the “lost to follow-up” (LTFU) from TB treatment. Myanmar is one of the 14 countries with high burden of TB, TB/HIV, and Multidrug-Resistant TB (MDR-TB). The aim of the study is to identify the factors associated with LTFU from TB treatment among migrant and mobile populations in Mon and Kayin States in Myanmar.

Methods: This was a prospective cohort study with a convergent mixed methods design. 146 new TB patients were surveyed and 14 “treatment after LTFU” patients were interviewed between June and September, 2016. Upon the treatment outcome data made available in February 2017, the survival analysis was conducted to measure the effect of potential predictors on time to LTFU during the full duration of treatment using Stata 14.0 version for Mac. Thematic networks analysis was applied to the qualitative data analysis by NVivo software 11.3.2 version for Mac.

Results: Of the 146 patients included, 10 (6.85%) new patients were LTFU from treatment. Having a family and/or community member support during the six to eight months’ treatment was a protective factor (Hazard Ratio (HR) 0.146; 95% CI 0.037 - 0.576; p = 0.0075), whereas the intention to stay for less than three months at the current place was a potential risk factor (HR 6.323; 95% CI 1.403 – 28.499; p = 0.0075) for getting LTFU from TB treatment. Having a lack of knowledge, but a positive attitude towards TB predisposed migrant TB patients to look for health education. However, financial constraint and social stigma of TB reinforced them to get LTFU from TB treatment. Poor provider-to-patient communication and barriers to accessibility of services were the enabling factors for the delay seeking care and treatment.

Conclusions: People on the move who are intended to stay in working area for less than 3 months are the high-risk group for TB treatment default. Having no family and/or community member support is a risk factor associated with tuberculosis treatment default among the migrant and mobile populations in Mon and Kayin States of Myanmar. National Tuberculosis Program should strengthen the existing multilateral community-based TB care with an integrated referral system inclusive of people on the move who are intended to stay in working area for less than three months. Fostering self-efficacy of TB patients by patient-centered communication and informed decision-making in the clinical setting as well as in the community will enable the better adherence to TB treatment among the migrant and mobile populations.