Pre-Diagnosis and Pre-Treatment Loss to Follow-Up Among Individuals with Presumptive Tuberculosis and Diabetes Mellitus: A Retrospective Study Using Routine Surveillance Data in Minahasa, North Sulawesi

Gordianus Lelang Wejak (Universitas Padjadjaran)
Doni Anshar Nuari (Universitas Padjadjaran)
Dika Pramita Destiani (Universitas Padjadjaran)
Ivan Surya Pradipta (Universitas Padjadjaran)

Jurnal Ilmiah Farmako Bahari
Vol 17 No 2 (2026): Jurnal Ilmiah Farmako Bahari

Tuberculosis (TB) remains a foremost infectious cause of death worldwide and stands as a major public health concern, particularly in high-burden countries such as Indonesia. Loss to follow-up (LTFU) during the early stages of the TB care cascade, including diagnostic evaluation and treatment initiation, contributes to under-detection and ongoing transmission. Patients with diabetes mellitus (DM) are at increased risk of TB and poor outcomes, with evidence on early-stage LTFU in this population remaining limited in specific settings such as district-level health systems. The objective of this study is to assess the proportion of pre-diagnosis and pre-treatment LTFU and to explore associated factors among presumptive TB individuals with DM. A retrospective cross-sectional study was performed using secondary data from Sistem Informasi Tuberkulosis (SITB). The study population comprised presumptive TB individuals with DM aged ≥18 years recorded between January 1 and November 30, 2025. Total sampling was applied. The chi-square or Fisher’s exact test was employed for bivariate statistical analysis. A p-value <0.05 was considered statistically significant. A total of 289 presumptive TB individuals with DM were included. Pre-diagnosis LTFU was 4.8 %, while pre-treatment LTFU was 6.4 %. Pre-diagnosis LTFU was significantly associated with area of residence (p=0.021), mode of entry into the TB program (p<0.001), and HIV status (p=0.037), suggesting that disparities in healthcare access and clinical characteristics may influence completion of the diagnostic process. No significant associations were observed for pre-treatment LTFU, likely due to the very limited number of events. Early-stage attrition in the TB-DM care cascade remains low but critical (4.8% pre-diagnosis and 6.4% pre-treatment LTFU). Geographical factors, entry points, and HIV comorbidity significantly influence diagnostic continuity. Minimizing patient loss requires strengthening localized tracking, enhancing referral coordination, and optimizing TB-HIV integration within routine health systems.