**7. Conclusion**

*Healthcare Access - Regional Overviews*

**6.6 Legislation**

*"A TSG is a non-statutory body of socially responsible citizens and volunteers to provide social support to each needy TB patient safeguarding his dignity and confidentiality by ensuring access to information, free and quality services and social welfare programs, empowering the patient for making decision to complete the treatment successfully."*

A TSG supports the various needs of the patient so that they can complete the anti-TB treatment without any worries. The package includes transportation service, treatment counseling, emotional and spiritual support, and providing accommodation for homeless TB patients. After the program was implemented, the rate of LTFU fell until it strikes zero in the latest cohorts. It is because it tackles the social dimension associated with LTFU. This is one program that the interviewed

In some countries, under certain circumstances, law enforcement is controversially used to solve the problem of LTFU. Usually, the patients who were LTFU were isolated in hospitals, but in some countries, they were isolated in prisons. Usually, this method was used against patients who were homeless and had a history of alcohol abuse [102]. When all the other methods fail, the medical officer, with the power given by the health laws, has to conduct a short-term incarceration of the patients who were LTFU. Detention of patients includes ethical and human right problems. The controversy surrounding this issue has been discussed in detail in a review article by Mburu et al. [103]. They discussed that the primary reason for detention is to protect public health, according to the Siracusa Principles adopted by the UN Economic and Social Council. However, they argued that this conflicts with the

*"…incarceration and detention approaches curtail the rights to health, informed consent, privacy, freedom from non-consensual treatment, freedom from inhumane and degrading treatment, and freedom of movement of people lost to follow-up. Detention could also worsen social inequalities and lead to a paradoxical increase in TB incidence."*

In the light of this information, the interventions which tackle the risk factors associated with LTFU are far superior to detention, which provides just a temporary

Another form of federal public health intervention is used in the USA to solve the problem of LTFU among the migrants [65]. These tools called the Do Not Board (DNB) and Border Lookout (BL) list are managed by the Department of Homeland Security (DHS) according to requests from the Centers for Disease Control and Prevention (CDC) Travel Restriction and Intervention expert workgroup. They are designed to detect land border travelers who were LTFU from TB treatment. State health departments and local health jurisdictions supply the list of patients and

*"(1) infectiousness or potential infectiousness with a communicable disease that would pose a public health threat if the individual travelled internationally;*

*(2) the person is unaware of his/her diagnosis, fails to adhere to public health recommendations, including treatment, or public health authorities are unable to* 

*(3) the person poses a risk to travel internationally or on a commercial flight" [65].*

patients from Ethiopia, who were LTFU, had hoped for [101].

international human right laws and the 1979 Alma-Ata Declaration.

solution to the problem, not a permanent one.

were reviewed under the following criteria:

*locate the person; and*

**120**

LTFU from treatment is a serious problem that cannot be ignored. Throughout this chapter, the consequences of LTFU, the magnitude of this problem in different countries, and the underlying factors have been discussed. Various researchers have designed potentially powerful interventions to tackle LTFU. But, we still need further evidence and actions to be able to successfully lower the number of patients that are LTFU. With these points in mind, it is suggested that an ambitious approach should be taken to reduce the number of LTFU patients up to 0%.
