Factors affecting delay in initiation of treatment of tuberculosis in the Thames Valley, UK

Saldana, Lisa; Abid, Maryam; McCarthy, Noel D.; Hunter, Nancy; Inglis, Rebecca; Anders, Katherine L.

doi:10.1016/j.puhe.2012.11.010

Cited by 27 publications

(36 citation statements)

References 7 publications

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“…Delays are probably due to diagnostic challenges of a negative first-line investigation, but also because positive smear is associated with more severe and clinically and radiologically obvious disease [15][16][17]. Consistent with previous observational data from the UK or United States examining healthcare delay or total delay, we found longer delays in females [8,18,19], native-born cases [9,10,[18][19][20], cases with longer time since migration [19] and cases referred by general practitioners [10]. One explanation for the above populations experiencing longer delays would be a low index of clinical suspicion in the examining clinician for cases whom they perceive as being at low risk of TB.…”

Section: Discussionsupporting

confidence: 88%

“…Potential risk factors were selected according to evidence from the literature [7][8][9][10], clinical plausibility in the England setting, and availability on ETS or cohort review databases. We used logistic regression to determine whether there was an association between linkage status and case characteristic to assess completeness of delay outcome data and whether outcome data completeness varied by case characteristic.…”

Section: Discussionmentioning

confidence: 99%

“…Older age has been associated with longer total delay [9,10,19], increased delays being most pronounced when comparing adults with children [9,19], and thought to be due to difficulties in recognising TB symptoms among other comorbidities, or less typical TB presentation. Similarly, we observed shorter presentation delay in children, and weak evidence of trends to longer healthcare delay with older age; we may have detected a significant effect with a larger cohort giving greater statistical power.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with delay in treatment initiation for pulmonary tuberculosis

et al. 2020

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BackgroundDelays in treatment initiation for tuberculosis (TB) may lead to worse clinical outcomes and increased transmission. We aimed to determine factors associated with treatment delays, to guide public health action.MethodsWe extracted data on clinical characteristics and documented potential barriers to treatment from all pulmonary TB cases with clinical case review data from 2011 to 2015 and linked these to TB surveillance data. We described the distribution of delays from symptom onset to first presentation (“presentation delay”) and from presentation to treatment (“healthcare delay”). We calculated time ratios (TRs) to determine the association between sociodemographic and clinical factors and delay outcomes.ResultsMedian presentation delay was 30 days (interquartile range (IQR) 11–72 days). Language barriers were associated with 40% longer presentation delay (TR 1.40, 1.01–1.94). Median healthcare delay was 40 days (IQR 13–89 days), and mostly consisted of the time taken before deciding to refer to TB specialists (median 26 days, IQR 4–73 days). Shorter healthcare delay was associated with positive sputum smear (TR 0.58, 0.47–0.70), UK residency <2 years (TR 0.47, 0.32–0.67), male sex (TR 0.74, 0.60–0.91) and secondary care referral (TR 0.63, 0.51–0.78).ConclusionsOur findings support continued initiatives to enable access to care for migrant populations to minimise presentation delay. Multifaceted approaches to increase clinician awareness of TB clinical presentations, to implement systems enabling early case recognition, to maximise the yield from sputum smear investigations and to ensure rapid diagnosis of smear negative cases are required to achieve further TB control.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Factors associated with delay in treatment initiation for pulmonary tuberculosis

et al. 2020

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“…Our study showed that TB cases who were female, aged 45 years and older, UK-born, resided outside London or had extrapulmonary TB were significantly more likely to have a delay in diagnosis of more than 4 months between onset of symptoms and starting treatment. Studies in similar countries with low TB incidence have described similar factors associated with diagnostic delay; however, none have used national-level data [4][5][6][7][8][9][10][11][12][13][14][15]. There has been one previous study in the UK using national leveldata to assess diagnostic delay among index cases and their contacts within households, which found that there was a median delay of 65 days for index cases and 61 days for subsequent symptomatic cases [16].…”

Section: Discussionmentioning

confidence: 99%

Delay from symptom onset to treatment start among tuberculosis patients in England, 2012–2015

et al. 2018

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Improving access to tuberculosis (TB) care and ensuring early diagnosis are two major aims of the WHO End TB strategy and the Collaborative TB Strategy for England. This study describes risk factors associated with diagnostic delay among TB cases in England. We conducted a retrospective cohort study of TB cases notified to the Enhanced TB Surveillance System in England between 2012 and 2015. Diagnostic delay was defined as more than 4 months between symptom onset and treatment start date. Multivariable logistic regression was used to identify demographic and clinical factors associated with diagnostic delay. Between 2012 and 2015, 22 422 TB cases were notified in England and included in the study. A third (7612) of TB cases had a diagnostic delay of more than 4 months. Being female, aged 45 years and older, residing outside of London and having extra-pulmonary TB disease were significantly associated with a diagnostic delay in the multivariable model (aOR = 1.2, 1.2, 1.2, 1.3, 1.8, respectively). This study identifies demographic and clinical factors associated with diagnostic delay, which will inform targeted interventions to improve access to care and early diagnosis among these groups, with the ultimate aim of helping reduce transmission and improve treatment outcomes for TB cases in England.

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“…Currently not all TB cases are diagnosed promptly in the EU as is shown by several studies [17, 18]. This may be due to insufficient knowledge of patients and health care workers about TB in areas with a low TB incidence [19].…”

Section: Discussionmentioning

confidence: 99%

Will the European Union reach the United Nations Millennium declaration target of a 50% reduction of tuberculosis mortality between 1990 and 2015?

2017

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BackgroundThe Millennium Development Goals (MDG) provide targets for 2015. MDG 6 includes a target to reduce the tuberculosis (TB) death rate by 50% compared with 1990. We aimed to assess whether this target was reached by the European Union (EU) and European Economic Area countries.MethodsWe used Eurostat causes of death data to assess whether the target was reached in the EU. We calculated the reduction in reported and adjusted death rates and the annual average percentage decline based on the available data.ResultsBetween 1999 and 2014, the TB death rate decreased by 50%, the adjusted death rate by 56% and the annual average percentage decline was 5.43% (95% confidence interval 4.94–6.74) for the EU. Twenty of 26 countries reporting >5 TB deaths in the first reporting year reached the target of 50% reduction in adjusted death rate.ConclusionsThe EU reached the MDG target of a 50% reduction of the TB death rate and also the annual average percentage decline was larger than the 2.73% needed to reach the target. The World Health Organization ‘End TB Strategy’ requires a further reduction of the number of TB deaths of 35% by 2020 compared to 2015, which will challenge TB prevention and care services in the EU.

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Factors affecting delay in initiation of treatment of tuberculosis in the Thames Valley, UK

Cited by 27 publications

References 7 publications

Factors associated with delay in treatment initiation for pulmonary tuberculosis

Factors associated with delay in treatment initiation for pulmonary tuberculosis

Delay from symptom onset to treatment start among tuberculosis patients in England, 2012–2015

Will the European Union reach the United Nations Millennium declaration target of a 50% reduction of tuberculosis mortality between 1990 and 2015?

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