Evaluating documentation of follow-up laboratory testing in TB treatment monitoring in the Eastern Region of Ghana: a consistency analysis of three facility registers.

backgroundThe World Health Organization (WHO) recommends systematic follow-up testing for all bacteriologically confirmed pulmonary TB (PTB) cases under treatment to track progress towards successful treatment completion. However, this topic has received little attention from researchers. We assessed the extent of documentation of follow-up laboratory testing for TB treatment monitoring.

methodsMatched and unmatched records of bacteriologically confirmed PTB cases recorded between January 2016 and December 2017 across three TB registers from five districts of the Eastern Region were analyzed to assess documentation of follow-up laboratory testing at recommended treatment time points (months 2/3, 5, and 6/8). A cross-register consistency analysis assessed agreement between follow-up testing records documented in the laboratory register and those recorded in the district TB register, with the laboratory register treated as the reference source. A logistic regression model was used to identify factors associated with documentation of follow-up laboratory testing.

resultsA total of 773 bacteriologically confirmed PTB cases were successfully matched across the three registers after record linkage. The mean age was 42.6 years (SD = ± 15.0). More than half of the PTB cases in the district register did not have follow-up test results documented at 2 or 3 months (62.9%, 95% CI: 59.4-66.2, p < 0.001), 5 months (72.5%, 95% CI: 69.2-75.5, p < 0.001), and 6 or 8 months (66.4%, 95% CI: 63.0-69.6, p < 0.001). Similarly, in the laboratory register, 45.8% of cases had missing follow-up laboratory test results at months 2 or 3, 65.9% at month 5, and 99.9% at month 6/8. In the treatment centre registers, 67.1%, 75.9%, and 75.4% of PTB cases did not have follow-up test results documented at months 2 or 3, 5, and 6 or 8, respectively. Cross-register consistency analysis showed that documentation status matched in more than half of the records across the assessed follow-up intervals, with the highest consistency observed at month 6/8 (66.3%; 95% CI: 62.8-69.5; p < 0.001). Adult age groups (15-64 years) had lower odds of having documented follow-up test results than children aged 0-14 years. PTB cases from the Kwahu West Municipality were more likely to have documented follow-up testing results (aOR: 3.9, 95% CI: 2.1-7.1, p < 0.001) compared to cases residing in Akyemansa District.

conclusionLogistic regression analysis showed that documented follow-up testing results were less common among several adult age groups than among children aged 0-14 years. Because this study assessed routine register documentation, this finding should be interpreted as a documentation gap rather than a confirmed absence of testing. Strengthening documentation practices and integrated reporting systems for follow-up testing should therefore be prioritized within the TB control programme.