T imely screening, diagnosis and treatment initiation are critical components for effective tuberculosis (TB) services. Studies from different countries have found an association between delayed treatment initiation and unfavourable treatment outcomes for drug-susceptible TB (DS-TB). [1][2][3][4] There is less evidence on the impact of delayed treatment initiation for drug resistant TB (DR-TB), although this may be due to methodological limitations in existing studies and programmatic factors that obscure any such effect. 5,6 Early diagnosis and prompt, effective TB treatment is important for infection control and for preventing transmission. [7][8][9][10][11][12] Infectiousness rapidly decreases once patients initiate effective treatment. 9,10 This is particularly important for preventing the transmission of DR-TB, which is more complex and costly to treat, and has lower treatment success rates globally compared to DS-TB. 13 Early, effective TB treatment is an important strategy for managing the infection risks that can result from the exposure of susceptible individuals to active TB disease in health facilities. 14 The staff of health facilities have been shown to be at increased risk of tuberculous infection and active TB disease relative to the general population. [15][16][17][18] On Daru Island, Western Province, Papua New Guinea (PNG), there is a high burden of TB, with a case notification rate of over 1% in the population. 19 Person-to-person transmission of DR-TB is apparent, with 69% of cases infected by primary transmission in 2017. An emergency response was commenced in Daru in 2015. Key components of the response included early access to rapid diagnostics and effective treatment. The Daru General Hospital also implemented the FAST strategy (Finding TB cases Actively, Separating safely, and Treating effectively), which emphasises rapid diagnosis and effective treatment. 11 Despite this, hospital staff have reported a number of challenges to early diagnosis and delays in treatment initiation.The time taken from patient presentation to treatment initiation has not been quantified following the commencement of the Emergency Response Taskforce for MDR and XDR-TB, and little is known about the factors that might influence the timeliness of diagnosis and treatment.This study aims to assess the timeliness of treatment initiation for TB patients presenting at Daru General Hospital and to identify patient characteristics associated with delayed treatment initiation.
METHODS
DesignThis was a retrospective cohort study reviewing routine programme data. The study included all TB patients started on treatment for DS-TB and DR-TB at Daru General Hospital from 1 January to 30 September 2017.
This book contains the abstracts of the papers presented at The 3rd Annual Graduate Entry Research in Medicine Conference (GERMCON 2020) Organized by Warwick Medical School, University of Warwick in collaboration with Swansea University Medical School, Swansea University, Wales, UK held on 12–18 October 2020. This was especially important for Graduate Entry Medical (GEM) students, who have less opportunity and time to engage in research due to their accelerated medical degree.
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