Treatment Delay among Pulmonary Tuberculosis Patients within the Pakistan National Tuberculosis Control Program

Saqib, Shahab E.; Ahmad, Mokbul Morshed; Amezcua‐Prieto, Carmen; Virginia, Martinez Ruiz

doi:10.4269/ajtmh.18-0001

Cited by 27 publications

(23 citation statements)

References 27 publications

(44 reference statements)

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“…TB-related stigma was independently associated with non-submission of sputum, consistent with findings from a study in India [22]. Several studies have reported high perception of TB-associated stigma [23][24][25][26][27], and specific actions are needed to counter this [28,29].…”

Section: Discussionsupporting

confidence: 79%

Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana

et al. 2020

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BackgroundGhana's national prevalence survey showed higher than expected tuberculosis (TB) prevalence, indicating that many people with TB are not identified and treated. This study aimed to identify gaps in the TB diagnostic cascade prior to starting treatment. MethodsA prospective cohort study was conducted in urban and rural health facilities in south-east Ghana. Consecutive patients routinely identified as needing a TB test were followed up for two months to find out if sputum was submitted and/or treatment started. The causal effect of health facility location on submitting sputum was assessed before risk factors were investigated using logistic regression. ResultsA total of 428 persons (mean age 48 years, 67.3% female) were recruited, 285 (66.6%) from urban and 143 (33.4%) from rural facilities. Of 410 (96%) individuals followed up, 290 (70.7%) submitted sputum, among which 27 (14.1%) had a positive result and started treatment. Among those who visited an urban facility, 245/267(91.8%) submitted sputum, compared to 45/143 (31.5%) who visited a rural facility. Participants recruited at the urban facility were far more likely to submit a sputum sample (odds ratio (OR) 24.24, 95%CI 13.84-42.51). After adjustment for confounding, there was still a strong association between attending the urban facility and submitting sputum (adjusted OR (aOR) 9.52, 95%CI 3.87-23.40). Travel distance of >10 km to the laboratory was the strongest predictor of not submitting sputum (aOR 0.12, 95%CI 0.05-0.33). ConclusionThe majority of presumptive TB patients attending a rural health facility did not submit sputum for testing, mainly due to the long travel distance to the laboratory. Bridging this gap in the diagnostic cascade may improve case detection.

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Section: Discussionsupporting

confidence: 79%

Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana

et al. 2020

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“…Treatment delay leads to more serious illness; as a result, it increased infectivity within the community and increased transmission of TB [ 3 , 4 ]. Delay in initiation of treatment gratuitously prolongs the period of TB transmission within the community [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Delay for Tuberculosis Treatment and Its Predictors among Adult Tuberculosis Patients at Debremarkos Town Public Health Facilities, North West Ethiopia

Ayalew

Yehualashet

Bogale

et al. 2020

Tuberculosis Research and Treatment

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Background. Delay in the diagnosis and treatment of tuberculosis exacerbates the disease and clinical outcomes. It further enhances transmission of the infection in the society as well as increased the severity of the illness and raised rate of mortality. Objectives. The major goal of this study is to determine the magnitude of delays in tuberculosis treatment and factors affecting tuberculosis treatment among adult tuberculosis patients at Debremarkos town, North West Ethiopia, 2018. Methods. Institution-based cross-sectional study design was employed. Systematically selected 300 adult TB patients were recruited to the study. The study was conducted at Debremarkos town public health facilities from March 1 to April 30, 2018. Logistic regression models were fitted to identify the predicting variables and control confounder’s of the outcome variables. P value ≤ 0.05 with 95% CI was considered as an indicator for the presence of statistically significant association. The result revealed that the median total delay was 23 days (IQR: 19-28 days). The median patient and health system delays were 20 days (IQR: 15-20 days) and 4 days (IQR: 3-5 days), respectively. Tuberculosis patients living in a rural area were 1.14 times more likely to delay for the TB treatment (AOR: 1.141, 95% CI (1.106, 2.608)). Patients who were unable to read and write have almost two times a chance of being delayed (AOR: 2.350, 95% CI (1.630, 2.608)). Monthly income of patients has found another predictor for delay; patients with low monthly income were about six times more likely to delay for TB treatment (AOR: 6.375, 95% CI: (1.733, 23.440)). Those TB patients who had visiting traditional healers before arrival to health facilities were about 2.7 times more likely to delay for TB treatment(AOR: 2.795, 95% CI (1.898, 8.693)). Conclusion and Recommendation. The significant proportion of delays in tuberculosis treatment was found in this study. Living in the rural area, unable to read and write, lower monthly income, and visiting traditional healers were found independent predictors of TB treatment delay. The regional and zonal health administrator shall design various awareness creation mechanisms to educate the public about timely initiation of tuberculosis treatment.

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“…2 Patients with LTFU (previously referred to as defaulted) often have poorer treatment outcomes, higher risk of relapse, and are more prone to developing drug resistance. 4 – 7 Improving treatment completion and reducing LTFU is a key step toward TB control in India.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Loss to Follow-Up among Men with Tuberculosis in Puducherry and Tamil Nadu, India

Zhou

Lakshminarayanan

Sarkar

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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Identifying predictors of loss to follow-up (LTFU; treatment lapse ³ 2 months) among people with tuberculosis (TB) may assist programmatic efforts in controlling the spread of TB. Newly diagnosed smear-positive TB patients were enrolled in the Regional Prospective Observational Research for TB study in Puducherry and Tamil Nadu, India. Treatment records were used to identify LTFU of those who were enrolled from May 2014 through December 2017. This nested case-control study evaluated male TB patients. Predictors were assessed using multivariable logistic regression. Of 425 men with TB, 82 (19%) were LTFU. In the adjusted analyses of males, divorced/separated marital status (adjusted odds ratio [aOR] 3.80; 95% CI: 1.39-10.38) and at-risk alcohol use (aOR 1.92; 95% CI: 1.12-3.27) were significant predictors for increased risk of LTFU, and diabetes was a significant predictor for decreased risk of LTFU (aOR 0.52; 95% CI: 0.29-0.92). Of 53 men with recorded date of last treatment visit, 23 (43%) and 43 (81%) had LTFU within the first 2 and first 4 months of treatment, respectively. Addressing at-risk alcohol use and providing more intensive follow-up could lead to improved treatment completion.

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Treatment Delay among Pulmonary Tuberculosis Patients within the Pakistan National Tuberculosis Control Program

Cited by 27 publications

References 27 publications

Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana

Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana

Delay for Tuberculosis Treatment and Its Predictors among Adult Tuberculosis Patients at Debremarkos Town Public Health Facilities, North West Ethiopia

Predictors of Loss to Follow-Up among Men with Tuberculosis in Puducherry and Tamil Nadu, India

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