A systematic review of delay in the diagnosis and treatment of tuberculosis

Storla, Dag Gundersen; Yimer, Solomon Abebe; Bjune, Gunnar

doi:10.1186/1471-2458-8-15

Cited by 801 publications

(883 citation statements)

References 16 publications

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“…Patients have to visit health services on their own for diagnosis [passive case finding (PCF)], and only after TB diagnosis does the programme takes up active responsibility to care for them [9]. The process to reach the health facilities could be time-consuming, cumbersome and costly [10–12]. As TB services are integrated with the general health system, the geographical, financial and social access barriers to TB care are similar to the barriers of accessing the general health system [4,13].…”

Section: Introductionmentioning

confidence: 99%

“…As TB services are integrated with the general health system, the geographical, financial and social access barriers to TB care are similar to the barriers of accessing the general health system [4,13]. Patients get trapped in a vicious circle of repeated visits to the same health care provider (HCP) or visits to multiple HCPs including private and traditional HCPs [8,10,11,14,15]. …”

Section: Introductionmentioning

confidence: 99%

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Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

Shewade

Gupta

Satyanarayana

et al. 2018

Global Health Action

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Background: There is limited evidence on whether active case finding (ACF) among marginalised and vulnerable populations mitigates the financial burden during tuberculosis (TB) diagnosis. Objectives: To determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding (PCF). Methods: In 18 randomly sampled ACF districts in India, during March 2016 to February 2017, we enrolled all new sputum-smear-positive TB patients detected through ACF and an equal number of randomly selected patients detected through PCF. Direct (medical and non-medical) and indirect costs due to TB diagnosis were collected through patient interviews at their residence. We defined costs due to TB diagnosis as ‘catastrophic’ if the total costs (direct and indirect) due to TB diagnosis exceeded 20% of annual pre-TB household income. We used concentration curves and indices to assess the extent of inequity. Results: When compared with patients detected through PCF (n = 231), ACF patients (n = 234) incurred lower median total costs (US$ 4.6 and 20.4, p < 0.001). The prevalence of catastrophic costs in ACF and PCF was 10.3 and 11.5% respectively. Adjusted analysis showed that patients detected through ACF had a 32% lower prevalence of catastrophic costs relative to PCF [adjusted prevalence ratio (95% CI): 0.68 (0.69, 0.97)]. The concentration indices (95% CI) for total costs in both ACF [−0.15 (−0.32, 0.11)] and PCF [−0.06 (−0.20, 0.08)] were not significantly different from the line of equality and each other. The concentration indices (95% CI) for catastrophic costs in both ACF [−0.60 (−0.81, –0.39)] and PCF [−0.58 (−0.78, –0.38)] were not significantly different from each other: however, both the curves had a significant distribution among the poorest quintiles. Conclusion: ACF among marginalised and vulnerable populations reduced total costs and prevalence of catastrophic costs due to TB diagnosis, but could not address inequity.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

Shewade

Gupta

Satyanarayana

et al. 2018

Global Health Action

View full text Add to dashboard Cite

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“…In this framework, the transmission rate, frequency of health-system contact and probability of successful diagnosis can all change S61 over time 19 . As an illustration, if patients remain infectious for an average of 10 months before seeking care and then begin to contact the health system once a month 28,29 , a 50% chance of successful diagnosis per visit would still result in a mean duration of infectiousness of 1 year -but increasing the probability of diagnosis from 0.5 to 0.75 would only reduce that duration to 11.3 months. Worse still, if most transmissions occur in the first 10 months, then even a perfect diagnostic test at the health facility could not avert those events.…”

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confidence: 99%

Understanding the incremental value of novel diagnostic tests for tuberculosis

Arinaminpathy

Dowdy

2015

Nature

109

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Tuberculosis is a major source of global mortality caused by infection, partly because of a tremendous ongoing burden of undiagnosed disease. Improved diagnostic technology may play an increasingly crucial part in global efforts to end tuberculosis, but the ability of diagnostic tests to curb tuberculosis transmission is dependent on multiple factors, including the time taken by a patient to seek health care, the patient's symptoms, and the patterns of transmission before diagnosis. Novel diagnostic assays for tuberculosis have conventionally been evaluated on the basis of characteristics such as sensitivity and specificity, using assumptions that probably overestimate the impact of diagnostic tests on transmission. We argue for a shift in focus to the evaluation of such tests' incremental value, defining outcomes that reflect each test's purpose (for example, transmissions averted) and comparing systems with the test against those without, in terms of those outcomes. Incremental value can also be measured in units of outcome per incremental unit of resource (for example, money or human capacity). Using a novel, simplified model of tuberculosis transmission that addresses some of the limitations of earlier tuberculosis diagnostic models, we demonstrate that the incremental value of any novel test depends not just on its accuracy, but also on elements such as patient behaviour, tuberculosis natural history and health systems. By integrating these factors into a single unified framework, we advance an approach to the evaluation of new diagnostic tests for tuberculosis that considers the incremental value at the population level and demonstrates how additional data could inform more-effective implementation of tuberculosis diagnostic tests under various conditions

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“…Previous studies have shown that a delay in diagnosis is closely related to poor access to health care 8,9 . Despite TB control programs' recommendation that diagnosis should be made at the primary health care level, most patients are still diagnosed in hospitals.…”

Section: Introductionmentioning

confidence: 99%

Health care seeking behavior and patient delay in tuberculosis diagnosis

2015

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Delays in diagnosis of TB cases are major impeding factors in the control of TB. The objectives of this study were to describe the health care seeking behavior of TB patients, assessing patient delay and the number of health care facilities visited before the start of TB treatment. A cross-sectional study was carried out with adult patients with pulmonary TB presenting to two TB facilities to start treatment. We found a median patient delay of 20 days. The factors associated negatively with patient delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom. We also demonstrated that 44.8% of patients incorrectly reported the mode of transmission of TB. In addition, the local of first attendance was an emergency room of public hospitals in 37.3% of patients. We demonstrated that the median patient delay in TB diagnosis in two TB services in a region with a high prevalence of TB was 20 days, and the protective factors associated with this delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom.

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A systematic review of delay in the diagnosis and treatment of tuberculosis

Cited by 801 publications

References 16 publications

Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

Understanding the incremental value of novel diagnostic tests for tuberculosis

Health care seeking behavior and patient delay in tuberculosis diagnosis

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