Characteristics associated with time to linkage from hospital referral to local treatment initiation for TB in rural South Africa.

This is based on complete case dataset (n = 669). (DOCX)</p

Time from hospital referral to presentation for initiation of treatment in rural South African clinics.

The black line represents the proportion of people who were referred from hospitals to local clinics for TB treatment and had successfully linked to care, by the number of days post-discharge shown on the x-axis. Of the 647 who linked to care, the plot does not include 90 people with missing or invalid date of presentation. The median time to linkage for the 557 people who linked to care and had a valid date of presentation was 4 days (IQR: 1, 14).</p

Patient flow diagram for study participants.

The patient flow diagram represents the cohort of people diagnosed with drug-sensitive TB at each study hospital between August 1, 2017 and April 30, 2018 who were followed via record review for establishing linkage to care. All participants were followed for a minimum of four months after TB diagnosis. Since the follow-up time varied for patients, not all patients had completed treatment by the time of record review.</p

S1 Data -

People with tuberculosis (TB) are often lost to follow-up during treatment transition to another facility. These losses may result in substantial morbidity and mortality but are rarely recorded. We conducted a record review on adults diagnosed with TB at 11 hospitals in Limpopo, South Africa, who were subsequently transferred to a local clinic to initiate or continue treatment. We then performed in-depth record reviews at the primary care clinic to which they were referred and called participants who could not be identified as starting treatment. Between August 2017 and April 2018, we reviewed records of 778 individuals diagnosed with TB in-hospital and later referred to local clinics for treatment. Of the 778, 88 (11%) did not link to care, and an additional 43 (5.5%) died. Compared to people without cough, those with cough had higher odds of linking to care (aOR = 2.01, 95% CI: 1.26–3.25, p = 0.005) and were also linked more quickly [adjusted Time Ratio (aTR) = 0.53, 95% CI:0.36–0.79, p</div

Characteristics associated with death of people with TB referred from hospital to local clinic for treatment initiation in rural South Africa.

This is based on complete case dataset (n = 669). This analysis considers deaths as all people who died during the study duration irrespective of time awaiting linkage to care or linkage to care status. Factors associated with death in the complete case analysis. People who died (n = 55) includes 24 and 31 people who died before and after linking to care, respectively. (DOCX)</p

Characteristics associated with death of people with TB referred from hospital to local clinic for treatment initiation in rural South Africa.

This analysis considers deaths as all people who died during the study duration irrespective of time awaiting linkage to care or linkage to care status. People who died (n = 76) includes 43 and 33 people who died before and after linking to care, respectively. (DOCX)</p

Characteristics associated with time to linkage from hospital referral to local treatment initiation for TB in rural South Africa.

This is based on complete case dataset. (n = 669). This analysis used competing-risk accelerated failure time model after imputing median time to linkage for missing values. Death was treated as an event with competing risk. Time to linkage to care was censored at 90 days. (DOCX)</p

Study hospitals.

In the study population, 52.2% had transferred-in to care from another facility, of whom 84% came from a hospital, 14% a clinic or private doctor, and data was missing for the remaining 1%. The 56 primary care clinics were purposively chosen based on volume of TB cases in the year prior to study, completeness of TB record keeping, and willingness to participate. (DOCX)</p

Characteristics associated with time to linkage from hospital referral to local treatment initiation for TB in rural South Africa.

Characteristics associated with time to linkage from hospital referral to local treatment initiation for TB in rural South Africa.</p