Correlates of Delayed Diagnosis among Human Immunodeficiency Virus-Infected Pulmonary Tuberculosis Suspects in a Rural HIV Clinic, South Africa

Abstract

Background. Delay in pulmonary tuberculosis (PTB) diagnosis is one of the major factors that affect outcome and threatens continued spread of tuberculosis. This study aimed at determining factors associated with delayed PTB diagnosis among human immunodeficiency virus (HIV) infected individuals. Methods. A retrospective observational study was done using clinic records of HIV-infected PTB suspects attending an HIV/AIDS clinic at Tintswalo rural hospital in South Africa (SA) between January 2006 and December 2007. Using routine clinic registers, 480 records were identified. Results. PTB diagnosis delay was found among 77/176 (43.8%) of the patients diagnosed with PTB. The mean delay of PTB diagnosis was 170.6 days; diagnosis delay ranged 1–30 days in 27 (35.1%) patients, 31–180 days in 24 (33.8%) patients; 24 (31.2%) patients remained undiagnosed for ≥180 days. Independent factors associated with delayed diagnosis were: older age >40 years (Odds Ratio (OR) 3.43, 95% CI 1.45–8.08) and virological failure (OR 2.72, 95% CI 1.09–6.74). Conclusion. There is a considerable delayed PTB diagnosis among HIV-infected patients in rural SA. Older patients as well as patients with high viral load are at a higher risk of PTB diagnosis delay. Therefore efforts to reduce PTB diagnosis delay need to emphasised.

Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders

“…Delayed disease diagnosis, as a consequence of poor access to healthcare services, has been demonstrated as one of the major problems in rural communities [2]. Point-of-care (POC) diagnostics has the potential to improve healthcare access in settings that have limited laboratory infrastructure.…”

Pulmonary tuberculosis diagnostic practices among people living with the human immunodeficiency virus in Lesotho

“…Improving adherence to the national diagnostic algorithm and the supply of laboratory commodities could significantly enhance diagnostic accuracy, reduce time to TB treatment initiation and improve treatment outcomes among PLHIV in Lesotho, and concurrent use of smear microscopy would allow for monitoring of treatment response. 5–8 …”

“…When compared to clinical diagnosis, bacteriological diagnosis of PTB improves diagnostic accuracy, and is associated with a shorter time to treatment initiation and lower loss to follow-up rates. 5–8 …”

Clinical outcomes and mortality associated factors in patients infected with HIV receiving a presumptive anti-tuberculosis treatment in a tertiary level hospital in Burkina Faso

“…According to other studies, application of the 2007 WHO's diagnostic algorithms for SNPTB and EPTB leads to a delay before TB-treatment initiation of 11-34 days (Getahun et al, 2007;Wilson et al, 2011); patients may then die from TB during this exploration period (Gray & Cohn, 2013). In our context, TB treatment may be initiated presumptively, but the delay is often too long, exposing patients to a higher risk of death or complications of HIV infection (Boniface et al, 2012;Bos et al, 2013). Other factors such as precarious economic situation (lack of health insurance system in the country and lack of access to health care for the poorest patients), serious immunosuppression, not receiving highly active antiretroviral therapy (HAART), or recent introduction of HAART, undiagnosed multiresistant TB could explain the high mortality rate (Otwombe et al, 2013;Sharma, Soneja, Prasad, & Ranjan, 2014).…”

“…The diagnosis of HIV-associated TB is often challenging due to atypical clinical and radiological presentation, higher rates of Smear-Negative Pulmonary TB (SNPTB) and Extra-Pulmonary TB (EPTB) (Getahun, Harrington, O'Brien, & Nunn, 2007;Gray & Cohn, 2013). The absence of simple and accurate rapid diagnosis tools is a common situation in sub-Saharan African countries leading to a delay in diagnosing SNPTB or EPTB and to the need to initiate anti-tuberculosis (anti-TB) treatment presumptively (Boniface, Moshabela, Zulliger, Macpherson, & Nyasulu, 2012;Otwombe, Variava, Holmes, Chaisson, & Martinson, 2013). Time of treatment initiation varies considerably according to studies and is usually long, leading to increased mortality (OMS, 2007).…”