Delays in the diagnosis of pulmonary tuberculosis in Coahuila, Mexico

Salinas, José Gutiérrez; Calvillo, S.; Caylà, Joan A.; Nedel, Fúlvio Borges; Martı́n, Marga; Navarro, Albert

doi:10.5588/ijtld.11.0476

Cited by 6 publications

(6 citation statements)

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“…[26] This decrease in patients presenting to a public health facility first in our study could be due to lack of awareness among the community about the availability of free and effective TB treatment services under the RNTCP. The median health system delay was 17 days, similar to those reported in Mwanza (15 days) [27] , Nepal (18 days) [20] and Mexico (18.5 days) [25] lower than that observed in Tanzania (28 days) [2] , Norway (33 days) [3] , Bangladesh (56 days) [22] and Iran (75 Days) [18] . This suggests that the health system delay was not the main problem in the area studied.…”

Section: Discussionsupporting

confidence: 69%

“…[24] In this study, the patient delay was the most important reason for total delay, a finding similar from a study in Mexico. [25] Our findings showed that a private clinic was the first point of contact for 68% of patients and a public health facility for 32% of patients, compared to respectively 43% and 47% in study from the southern part of India. [26] This decrease in patients presenting to a public health facility first in our study could be due to lack of awareness among the community about the availability of free and effective TB treatment services under the RNTCP.…”

Section: Discussionmentioning

confidence: 71%

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Determinants of delays in diagnosis and treatment of pulmonary tuberculosis in a new urban township in India: A cross-sectional study

Konda¹,

Melo²,

Giri³

et al. 2014

Int J Med Sci Public Health

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Background: The period of infectiousness of a new sputum smear-positive pulmonary tuberculosis case is important in determining the risk of exposure faced by the community. Early detection and effective treatment of TB case reduces the period of transmission and the risk of exposure of the community. It is for this reason that the delay in TB diagnosis and treatment should be minimal to control disease transmission and patient suffering. Aims & Objective: To measure delays in diagnosis and treatment of pulmonary tuberculosis, and to identify and assess the risk factors associated with these delays. Material and Methods: A cross-sectional study was conducted of all new smear-positive pulmonary TB patients diagnosed between January 2012 and June 2013 at RNTCP clinic. The time from the onset of symptoms to first health care consultation (patient delay) and the time from first health care consultation to the date of TB diagnosis (health system delay) were analysed. Bivariate and logistics regression were applied to analyse the risk factors of delays. Results: A total of 122 patients with a mean age of 29.9 years were included in the study. Mean total delay between the onset of symptoms and treatment initiation was 53.42 days (median 50, range 14-128), with a mean patient delay of 29.24 days (median 25, range 5-94) and mean health system delay of 21.7 days (median 17, range 3-93). The mean treatment delay was 2.48 days (median 2, range 1-6). Factors independently associated with total delay were cough symptom (OR 3.36, P = 0.038), completed secondary school (OR 0.41, P = 0.018), good knowledge of TB symptoms (OR 0.39, P = 0.011), first visit to a public health facility (OR 0.45, P = 0.044), sputum testing at first health care consultation (OR 0.46, P = 0.048) and stigma attached to TB disease (OR 2.89, P = 0.021). Those associated with patient delay were male sex (OR 0.42, P = 0.020), large family size (OR 2.30, P = 0.027), completed secondary school (OR 0.43, P = 0.025) and good knowledge of TB symptoms (OR 0.45, P = 0.029); while those associated with health system delay were first visit to a public health facility (OR 0.31, P = 0.006), sputum testing at first health care consultation (OR 0.22, P = 0.001), number of health care consultations (OR 4.41, P < 0.001) and pre-diagnosis health care cost (OR 3.35, P = 0.001). Conclusion: Health system delay was an important problem in the area studied, with patient delay being of most concern.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 71%

Determinants of delays in diagnosis and treatment of pulmonary tuberculosis in a new urban township in India: A cross-sectional study

Konda¹,

Melo²,

Giri³

et al. 2014

Int J Med Sci Public Health

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“…Similar analyses in other settings have revealed treatment delays by private providers and have proposed that these may be due to “deficiencies” [3], poorer knowledge regarding TB management [7, 8] or a lack of “effective diagnostic tools and follow-up routines” [2]. Although these factors may well be contributing, most previous studies did not consider important covariables, such as sputum smear status, which have previously been associated with health system delays [28] and that we found to be an important confounder in analyses of treatment commencement.…”

Section: Discussionmentioning

confidence: 82%

“…However, reports from a variety of contexts have suggested differences in the timely diagnosis and initiation of therapy between public and private sectors [2]. Longer delays have been identified in the private sector, including treatment delays (variably defined as the time from symptom onset to either smear test result, diagnosis or treatment commencement) [3–6] and health system delays (time from healthcare presentation to treatment initiation) [7–9]. Surveys of private providers have revealed TB patient management practices that fall short of recommended guidelines in various settings [10–16].…”

Section: Introductionmentioning

confidence: 99%

Comparing tuberculosis management under public and private healthcare providers: Victoria, Australia, 2002–2015

Dale

Tay²,

Trauer

et al. 2017

BMC Infect Dis

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BackgroundPrivate healthcare providers are important to tuberculosis (TB) management globally, although internationally there are reports of suboptimal management and disparities in treatment commencement in the private sector. We compared the management of TB patients receiving private versus public healthcare in Victoria, an industrialised setting with low tuberculosis (TB) incidence.MethodsRetrospective cohort study: 2002–2015. Private healthcare provision was included as an independent variable in several multivariate logistic and Cox proportional hazard regression models that assessed a range of outcome variables, encompassing treatment commencement delays, management and treatment outcomes.ResultsOf 5106 patients, 275 (5.4%) exclusively saw private providers, and 4714 (92.32%) public. Private care was associated with a shorter delay to presentation (HR 1.36, p = 0.065, 95% CI 1.02–2.00). Private patients were less likely to have genotypic testing (OR 0.66, p = 0.009, 95% CI 0.48–0.90), those with pulmonary involvement were less likely to have a sputum smear (OR 0.52, p = 0.011, 95% CI 0.31–0.86) and provided samples were less likely to be positive (OR 0.54, p = 0.070, 95% CI 0.27–1.05). Private patients with extrapulmonary TB were less likely to have a smear sample (OR 0.7, 95% CI 0.48–0.90, p = 0.009) and radiological abnormalities (OR 0.71, p = 0.070, 95% CI 0.27–1.05). Treatment commencement delays from presentation were comparable for cases with pulmonary involvement and extrapulmonary TB, although public extrapulmonary TB patients received radiological examinations slightly earlier than private patients (HR 0.79, p = 0.043, 95% CI 0.63–0.99) and public patients with pulmonary involvement from high burden settings commenced treatment following an abnormal CXR more promptly than their private counterparts (HR 0.41, p = 0.011, 95% CI 0.21–0.81). Private patients were more likely to receive <4 first-line medications (OR 2.17, p = 0.001, 95% CI 1.36–3.46), but treatment outcomes were comparable between sectors.ConclusionsThe differences we identified are likely to reflect differing case-mix as well as clinician practice. Sputum smear status was an important covariable in our analysis; with its addition we found no significant disparity in the health-system delay to treatment commencement between sectors. Our study highlights the importance of TB programs engaging with private providers, enabling comprehensive data collection that is necessary for thorough and true comparison of TB management and optimisation of care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2421-x) contains supplementary material, which is available to authorized users.

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“…Studies from Mexico, Nicaragua, and Peru have shown that substantial proportions of people with TB initially seek care in private sector facilities. [13][14][15] A study from Brazil found that a relatively small, albeit growing, percentage of TB diagnostic tests were performed in the private sector. 16 However, among the 78 studies included in a systematic review of public-private partnership models for TB, 12 only one originated from Latin America, and it focused on the involvement of private pharmacies rather than private health facilities.…”

Section: Introductionmentioning

confidence: 99%

Exploring the role of the private sector in tuberculosis detection and management in Lima, Peru: a mixed-methods patient pathway analysis

Wippel,

Farroñay,

Gilbert

et al. 2023

Preprint

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In Latin America, little is known about the involvement of private healthcare providers in TB detection and management. We sought to gain a better understanding of current and potential roles of the private sector in delivering TB services in Peru. We conducted a mixed-methods study in Lima, Peru. The quantitative component comprised a patient pathway analysis assessing the alignment of TB services with patient care-seeking behavior. The qualitative component comprised in-depth interviews with 18 private healthcare providers and 5 key informants. We estimated that 77% of patients initially sought care at a facility with TB diagnostic capacity and 59% at a facility with TB treatment capacity. The lack of TB services at initial care-seeking location was driven by the 41% of patients estimated to seek care first at a private facility. Among private facilities, 43% offered smear microscopy, 13% offered radiography, and none provided TB treatment. Among public sector facilities, 100% offered smear microscopy, 26% offered radiography, and 99% provided TB treatment. Interviews revealed that private providers believed that they offered shorter wait times and a quicker diagnosis, but they struggled with a lack of follow-up systems and communication barriers with the public sector. While expressing willingness to collaborate with public sector programs for diagnosis and referral, private providers had limited interest in treating TB. This study highlights the role of private providers in Peru as an entry point for TB care. Public-private collaboration is necessary to harness the potential of the private sector as an ally for early diagnosis.

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Delays in the diagnosis of pulmonary tuberculosis in Coahuila, Mexico

Abstract: In Coahuila, lack of formal education, living ≥5 km from a health unit, first consultation with a private physician, and being aged ≥46 years contributed to delays in PTB diagnosis.

Cited by 6 publications

References 0 publications

Determinants of delays in diagnosis and treatment of pulmonary tuberculosis in a new urban township in India: A cross-sectional study

Determinants of delays in diagnosis and treatment of pulmonary tuberculosis in a new urban township in India: A cross-sectional study

Comparing tuberculosis management under public and private healthcare providers: Victoria, Australia, 2002–2015

Exploring the role of the private sector in tuberculosis detection and management in Lima, Peru: a mixed-methods patient pathway analysis

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