Lessons from a systematic tracing process aimed to reduce initial loss to follow-up (ILTFU) among people diagnosed with tuberculosis (TB) in Cape Town, South Africa

Abstract Background South Africa is a high tuberculosis (TB) burdened country. People who are newly diagnosed with TB must link to a TB treatment facility and be registered in the electronic TB notification system for ongoing care. Delays in linking to care increase the risk of disease progression, TB morbidity and mortality, and ongoing TB transmission. We describe lessons learned from a systematic tracing process aimed to support linkage to care for people diagnosed with TB. Methods Using the Western Cape Provincial Health Data Centre (PHDC), we identified persons newly diagnosed with TB (January-December 2020) who were not recorded as linked to care after routine linking efforts, in one peri-urban health sub-district in Cape Town, South Africa. We followed a systematic tracing process; we included visits to primary health care (PHC) facilities to verify linkage status for these persons and then home-based tracing for all people with no evidence of linkage at PHC level. We plotted our systematic process and used the PHDC to determine demographic, clinical characteristics, and linkage outcomes five months after the end of the process. Results Within the PHDC, 406 persons diagnosed with TB had no evidence of being linked to TB care. Verification at PHC facilities found that 153/406 (38%) had linked to care at facility level. Of the remaining 253 requiring tracing, 34 (13%) had an address outside the study area and/or no contact details. We traced 219 persons, of which 112 (51%) were found and referred to care. The remaining 107 (49%) could not be found. Overall linkage to care was 76% among those we traced and found and 72% among those we could not find. Conclusion Implementing a systematic tracing process was useful for understanding many of the underlying complexities around delayed linkage to care. Lessons learned showed that accurate data captured in ‘real time’ at health facilities will improve record keeping and allow for resources to be focused on patients who are truly lost to follow-up and require home-based tracing. Updated contact details will increase the opportunity of finding persons during tracing.