Tuberculosis treatment delays and associated factors within the Zimbabwe national tuberculosis programme

Abstract

BackgroundDelayed presentation of pulmonary TB (PTB) patients for treatment from onset of symptoms remains a threat to controlling individual disease progression and TB transmission in the community. Currently, there is insufficient information about treatment delays in Zimbabwe, and we therefore determined the extent of patient and health systems delays and their associated factors in patients with microbiologically confirmed PTB.MethodsA structured questionnaire was administered at 47 randomly selected health facilities in Zimbabwe by trained health workers to all patients aged ≥18 years with microbiologically confirmed PTB who were started on TB treatment and entered in the health facility TB registers between 01 January and 31 March 2013. Multivariate logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CIs) for associations between patient/health system characteristics and patient delay >30 days or health system delay >4 days.ResultsOf the 383 recruited patients, 211(55%) were male with an overall median age of 34 years (IQR, 28-43). There was a median of 28 days (IQR, 21-63) for patient delays and 2 days (IQR, 1-5) for health system delays with 184 (48%) and 118 (31%) TB patients experiencing health system delays >30 days and health system delays >4 days respectively. Starting TB treatment at rural primary healthcare vs district/mission facilities [aOR 2.70, 95% CI 1.27-5.75, p = 0.01] and taking self-medication [aOR 2.33, 95% CI 1.23-4.43, p = 0.01] were associated with encountering patient delays. Associated with health system delays were accessing treatment from lower level facilities [aOR 2.67, 95% CI 1.18-6.07, p = 0.019], having a Gene Xpert TB diagnosis [aOR 0.21, 95% CI 0.07-0.66, p = 0.008] and >4 health facility visits prior to TB diagnosis [(aOR) 3.34, 95% CI 1.11-10.03, p = 0.045].ConclusionPatient delays were longer and more prevalent, suggesting the need for strategies aimed at promoting timely seeking of appropriate medical consultation among presumptive TB patients. Health system delays were uncommon, suggesting a fairly efficient response to microbiologically confirmed PTB cases. Identified risk factors should be explored further and specific strategies aimed at addressing these factors should be identified in order to lessen patient and health system delays.

Diagnosis and treatment of TB patients with rifampicin resistance detected using Xpert® MTB/RIF in Zimbabwe

“…26 Possible reasons for delays in starting treatment in Zimbabwe might be the time taken in conducting the baseline biochemistry tests on liver and renal function and the decision to start MDR-TB treatment, which is made by the clinical management team. Previous studies conducted elsewhere have shown that delayed treatment is due to a combination of patient and health system factors, [27][28][29] and these need to be addressed.…”

Monitoring and Evaluation of Program Performance and Management Control System of Tuberculosis: A Ten-Year Cross-Sectional Study in Sistan and Baluchestan Province, Iran

“…The findings showed that other factors, such as age, alcohol consumption, tobacco use, improper nutrition, and lack of access to health facilities and local medicines increased the rate of treatment failure and reduced the success of TB treatment (3,8). The middle line of the figure shows the results of the current system and indicates a completely downward trend in TB recurrence during 2006 -2016.…”

“…One of the main tasks of all healthcare systems is management of diseases. It is clear that the management system should be designed and implemented with respect to diseases, facilities, and needs proportionate to resources (4)(5)(6)(7)(8). The incidence and prevalence of TB are not similar in all parts of Iran.…”

“…Accurate and complete treatment and management of TB are the most important approaches for the control and prevention of this disease (8). Each year, relevant indicators are measured to determine the success or failure of programs, and management solutions are presented in the province to address the shortcomings (9,10).…”

Do Xpert MTB/Rif Cycle Threshold Values Provide Information About Patient Delays for Tuberculosis Diagnosis?

“…Ct values have been found to predict decreasing bacterial burden with increasing immunosuppression and a combination of Ct values and sputum smear status to be a possible measure of bacterial burden in high HIV-burden settings [5]. Several studies have documented the various factors associated with patient delay for TB diagnosis [6,7,8,9,10,11,12,13,14]. Mycobacterial load is likely to increase with patient delay since bacillary burden has been found to grow over time and may have an impact on the novel diagnostic tests [15,16].…”