. 2021 Sep 22;40:101127. doi: 10.1016/j.eclinm.2021.101127

Table 4.

Pre-treatment LTFU, time from symptoms to first contact with health services, diagnosis and treatment start reported in n=7 observational studies

First author, Population	Screening tools TB case definition	Outcomes						Comments
General population
Pre-treatment LTFU				N	n	%	95%CI
Gopi 2005 India	CXR and symptoms Smear +ve	-	Screened	243	57	23	18-29	Screened group – no deaths. Reasons for defaulting included not interested in initiating treatment, symptoms too mild, too sick/old and work-related problems. PCF group – 19% died from among those for whom a default reason was known.
Gopi 2005 India	CXR and symptoms Smear +ve	-	PCF	1049	156	15	13-17
Balasubramanian 2004 India	CXR and symptoms Smear +ve	-	Screened	231	68	29	24-36
Balasubramanian 2004 India	CXR and symptoms Smear +ve	-	PCF	833	120	14	12-17


Time to first contact with health services				N	n	%	p-value


Santha, 2003 India	CXR and symptoms Smear +ve	Cough <3 weeks	Screened	96	27	28	<0.001	Baseline characteristics of all (smear +ve and -ve) diagnosed in screened and on treatment in PCF groups - screened group more likely to be older, male, illiterate, sole earner, have poor quality house, 1 room house, lower smear grade and new smear -ve disease.
Santha, 2003 India	CXR and symptoms Smear +ve	Cough <3 weeks	PCF	272	35	13	<0.001


Time to diagnosis				N	Mean	SD	p-value

Abdurrahman 2016^∆ Nigeria	Symptoms Smear +ve	Cough duration in weeks	Screened	485	10.3	2.4	<0.001	Baseline characteristics of diagnosed TB patients (screened vs PCF) - screened group more likely to be older, married and less likely to be HIV infected.
Abdurrahman 2016^∆ Nigeria	Symptoms Smear +ve	Cough duration in weeks	PCF	209	6.8	2.6	<0.001


Time to treatment				N	n	%	p-value

Shargie, 2006 Ethiopia	Symptoms or on TB treatment Smear +ve	Symptom ≤90 days	Screened	13	6	46	1	Baseline characteristics of on treatment TB patients (screened vs PCF) - screened group younger and a higher proportion were women.
Shargie, 2006 Ethiopia	Symptoms or on TB treatment Smear +ve	Symptom ≤90 days	PCF	24	10	42	1


Risk groups

Time to diagnosis				N	Median	IQR	p-value

Shewade, 2019 India Marginalised/ vulnerable populations*	Symptoms Smear +ve	Patient-level diagnosis delay from sputum eligible^† (days)	Screened	225	12	3-31	0.999	Baseline characteristics of on treatment TB patients (screened vs PCF)- screened group more likely to be older, from rural areas, less educated and live further from microscopy units. Adjusted analysis showed no association between patient-level delay and case-finding, but showed reduction in total diagnosis delay among those screened (screened versus PCF linear regression of log transformed delay in days after adjusting for confounders and clustering beta coefficient -0.31; 95%CI -0.62 to 0.00; p=0.052; screened versus PCF adjusted prevalence ratio for delay ≥50 days 0.77; 95%CI 0.63-0.94; p=0.009)
		Patient-level diagnosis delay from sputum eligible^† (days)	PCF	230	10	3-43	0.999
		Health system diagnosis delay^Ŧ (days)	Screened	229	5	0-61	0.008
		Health system diagnosis delay^Ŧ (days)	PCF	229	19	1-76	0.008
		Total diagnosis delay^¶ (days)	Screened	229	45	18-106	0.131
		Total diagnosis delay^¶ (days)	PCF	230	61	20-121	0.131
Verver, 2001 Netherlands Migrants	CXR Smear or culture +ve	Symptom duration in weeks among those reporting symptoms	Screened	142	0.0	-	<0.001^ʃ	Baseline characteristics of on treatment TB patients (screened vs PCF) - screen detection varied by country of origin, decreased with increasing length of stay and was less likely among illegal migrants.
Verver, 2001 Netherlands Migrants	CXR Smear or culture +ve	Symptom duration in weeks among those reporting symptoms	PCF	332	7.5	-	<0.001^ʃ


Time to treatment				N	Median	IQR	p-value

Shewade, 2019 India Marginalised/ vulnerable populations*	Symptoms Smear +ve	Total treatment delay from sputum eligible^ï (days)	Screened	227	52	22-112	0.37	Baseline characteristics of on treatment TB patients (screened vs PCF)- screened group more likely to be older, from rural areas, less educated and live further from microscopy units. Adjusted analysis showed no association with case-finding (screened versus PCF linear regression of log transformed delay in days after adjusting for confounders and clustering beta coefficient -0.20; 95%CI -0.50 to 0.10; p=0.181).
Shewade, 2019 India Marginalised/ vulnerable populations*	Symptoms Smear +ve	Total treatment delay from sputum eligible^ï (days)	PCF	229	62	23-128	0.37

LTFU=loss to follow-up; pre-treatment LTFU=default between diagnosis and treatment start; N=total number of people with TB; n=number with outcomes; %=proportion; 95%CI=95% confidence interval; CXR=chest radiograph; +ve=positive; PCF=passive case-finding; -ve=negative; IQR=interquartile range; SD=standard deviation; ∆Other symptom (fever, weight loss, chest pain and anorexia) durations to diagnosis were assessed, only weight loss was significantly higher in the screened population compared to passively found TB patients;*included slums, tribal areas, scheduled caste communities, areas where occupational lung diseases is high, areas where individuals with high risk of acquiring TB reside including stone crushing/mining/weaving industry/unorganized labour (construction workers etc)/homeless, high HIV/AIDS burden areas, areas or communities with high TB incidence (including prisons) and among household contacts of sputum smear positive TB patients; †patient diagnosis delay=from sputum eligible (15^th day of continuous cough/fever or day of the first episode of haemoptysis) to first visit to health care provider.

^Ŧ

health system diagnosis delay=from first visit to health care provider to date of diagnosis; ¶total diagnosis delay=from eligible for sputum examination to diagnosis; ʃsimilar difference observed when results were restricted to n=99 with smear positive disease; ïtotal treatment delay= from sputum eligible (15^th day of continuous cough/fever or day of the first episode of haemoptysis) to treatment start.