Patient mobility and travel distance to receive drug-resistant tuberculosis treatment, and their associations with loss to follow-up in Guizhou Province, China

BACKGROUND: Drug-resistant tuberculosis (DR-TB) remains a public health crisis, with loss to follow-up (LTFU) being a crucial factor influencing its management. To inform effective TB control strategies, this study aimed to assess patient mobility, travel distances, and their associations with LTFU among DR-TB patients in Guizhou Province, China. METHODS: Data were collected from a national tuberculosis surveillance system from 2019 to 2021. Patients were classified as non-movers (treated at a hospital within the same prefecture) or movers (treated at a hospital in a different prefecture). Two travel distances were measured using AutoNavi: Distance 1 (home to treatment hospital) and Distance 2 (home to local hospital). The difference between these distances was categorized as follows: (1) Equal distance, (2) Long-distance travel (Distance 1 > Distance 2), and (3) Short-distance travel (Distance 1 < Distance 2). Three logistic regression models assessed associations between exposures (movers vs. non-movers in Model 1, long vs. short Distance 1 in Model 2, long-distance travel vs. equal distance in Model 3) and LTFU. RESULTS: Guizhou Province has nine prefectures, each with a designated DR-TB hospital. Of the 936 patients studied, 703 (75.1%) were from seven less developed prefectures, and 427 (60.7%) sought treatment in two developed prefectures. The two hospitals provided care for 660 (70.5%) patients (Guiyang: 547 patients, 58.4%; Zunyi: 113 patients, 12.1%). Among movers, 72.2% lived more than 100 km away. Overall, 28.5% of patients were LTFU. Adjusted analysis showed that movers had a higher LTFU risk [aOR = 1.49; 95% CI (1.04, 2.13) in Model 1], especially those with over 145 km Distance 1 [aOR = 1.74; 95% CI (1.11, 2.75) in Model 2] and long-distance travel [aOR = 1.45; 95% CI (1.01, 2.10) in Model 3]. CONCLUSION: DR-TB patients often travel from less developed prefectures to two major cities in Guizhou for better care. Patient mobility and travel burdens increase the risk of LTFU. Our study emphasizes the need to strengthen hospital infrastructure, improve DR-TB diagnosis and treatment in underdeveloped areas, and establish effective medication management and follow-up systems across all designated hospitals in the province to reduce DR-TB transmission and LTFU rates.