Consulting private health care providers aggravates treatment delay in urban South African tuberculosis patients.

Abstract

SETTING:

An urban primary health care facility in Khayelitsha, South Africa.

OBJECTIVES:

To determine the difference in total tuberculosis (TB) treatment delay in patients who initially seek care at National TB Control Programme (NTP) facilities after the onset of TB-related symptoms, compared to patients who initially seek care from non-NTP health care practitioners (HCP); and to describe the relative contributions of diagnostic, treatment initiation, patient and health system (HS) delay.

DESIGN:

A cross-sectional study of adult TB patients treated by the NTP.

RESULTS:

A total of 210 patients (median age 31 years) were enrolled from May to December 2009: 46% were male, and 58% were human immunodeficiency virus (HIV) infected. The median duration of total delay was 31 days, diagnostic delay 26, treatment initiation delay 0, patient delay 8 and HS delay 17 days. Initial visit to a non-NTP HCP was independently associated with total (P = 0.007), HS (P = 0.014) and diagnostic delays (P = 0.012). HIV infection was an independent risk factor for total (P = 0.047) and HS delay (P = 0.021); 27% of patients reported first going to a non-NTP HCP.

CONCLUSION:

Initial care sought from non-NTP HCP was the main determinant of total, HS and diagnostic delays. Engagement and education of private HCPs is recommended.

• Authors: S S Van Wyk, D A Enarson, N Beyers, C Lombard, A C Hesseling
• Journal: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease (Int J Tuberc Lung Dis) Vol. 15 Issue 8 Pg. 1069-76 (Aug 2011) ISSN: 1815-7920 [Electronic] France
• PMID: 21740670 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Antitubercular Agents

Topics

• Adult
• Antitubercular Agents (therapeutic use)
• Chi-Square Distribution
• Cross-Sectional Studies
• Delayed Diagnosis (statistics & numerical data)
• Female
• Health Services Accessibility (statistics & numerical data)
• Humans
• Male
• National Health Programs (statistics & numerical data)
• Private Sector (statistics & numerical data)
• Public Sector (statistics & numerical data)
• Referral and Consultation (statistics & numerical data)
• Regression Analysis
• Risk Assessment
• Risk Factors
• South Africa (epidemiology)
• Time Factors
• Tuberculosis (diagnosis, drug therapy, epidemiology)
• Urban Health Services (statistics & numerical data)