Healthcare seeking patterns for TB symptoms: Findings from the first national TB prevalence survey of South Africa, 2017–2019

Abstract

Background Although tuberculosis (TB) symptoms have limited sensitivity they remain an important entry point into the TB care cascade. Objectives To investigate self-reported healthcare seeking for TB symptoms in participants in a community-based survey. Methods We compared reasons for not seeking care in participants reporting ≥1 of four TB screening symptoms (cough, weight loss, night sweats, fever) in the first South African national TB prevalence survey (2017–2019). We used logistic regression analyses to identify sociodemographic and clinical characteristics associated with healthcare seeking. Results 5,168/35,191 (14.7%) survey participants reported TB symptoms and 3,442/5168 had not sought healthcare. 2,064/3,442(60.0%) participants intended to seek care, 912 (26.5%) regarded symptoms as benign, 399 (11.6%) reported access barriers(distance and cost), 36 (1.0%) took other medications and 20(0.6%) reported health system barriers. Of the 57/98 symptomatic participants diagnosed with bacteriologically confirmed TB who had not sought care: 38(66.7%) intended to do so, 8(14.0%) regarded symptoms as benign, and 6(10.5%) reported access barriers. Among these 98, those with unknown HIV status(OR 0.16 95% CI 0.03–0.82), p = 0.03 and those who smoked tobacco products(OR 0.39, 95% CI 0.17–0.89, p = 0.03) were significantly less likely to seek care. Conclusions People with TB symptoms delayed seeking healthcare, many regarded symptoms as benign while others faced access barriers. Those with unknown HIV status were significantly less likely to seek care. Strengthening community-based TB awareness and screening programmes together with self-screening models could increase awareness of the significance of TB symptoms and contribute to improving healthcare seeking and enable many people with TB to enter the TB care cascade.

Validation of a brief screener for broad-spectrum mental and substance-use disorders in South Africa

“…South Africa bears a heavy and unsustainable burden of both TB and HIV individually, and nearly 60% of individuals with TB are also living with HIV (South African National Department of Health, 2021). It is further estimated that one-in-five people living with HIV (PLWH) have a comorbid mental disorder (Myer et al, 2008;Zuma et al, 2022) and approximately one-in-three individuals with TBwith or without HIV coinfection -experience severe psychological distress (Peltzer et al, 2012(Peltzer et al, , 2013Walt and Moyo, 2018;Janse Van Rensburg et al, 2020). The high rates of mental disorders and infectious diseases, particularly HIV and TB, highlight the need for task-sharing mental health services and validated screening tools.…”

Prevalence and risk factors of M tuberculosis infection in young people across 14 communities in Zambia and South Africa

“…A recent analysis the 2013–2014 Zambian National TB prevalence survey data showed that about 40.5% with bacteriologically confirmed TB were asymptomatic for cough ≥2 weeks [ 28 ]. In a cross-sectional survey in South Africa between 2017–2019, 57.5% of bacteriologically confirmed TB occurred in those who were asymptomatic but had chest Xray abnormalities [ 29 ].…”