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

• Published in: The international journal of tuberculosis and lung disease Vol. 15; no. 8; pp. 1069 - 1076
• Main Authors: VAN WYK, S. S, ENARSON, D. A, BEYERS, N, LOMBARD, C, HESSELING, A. C
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01-08-2011; International Union against Tuberculosis and Lung Disease
• Subjects: Adult; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Chi-Square Distribution; Cross-Sectional Studies; Delayed Diagnosis - statistics & numerical data; Diagnostic Delay; Female; Health Services Accessibility - statistics & numerical data; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Mycobacterium; National Health Programs - statistics & numerical data; Pneumology; Private Sector; Private Sector - statistics & numerical data; Public Sector; Public Sector - statistics & numerical data; Referral and Consultation - statistics & numerical data; Regression Analysis; Respiratory system : syndromes and miscellaneous diseases; Risk Assessment; Risk Factors; South Africa - epidemiology; Time Factors; Treatment Delay; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis and atypical mycobacterial infections; Urban Health Services - statistics & numerical data; South Africa; Human; diagnostic delay; Respiratory disease; Health; public sector; Urban area; Mycobacterial infection; treatment delay; Care; African; Infection; Treatment; Tuberculosis; Bacteriosis; Diagnosis; Private sector; Pneumology
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.10.0615

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.