title: Completeness and timeliness of treatment initiation after laboratory diagnosis of tuberculosis in Gaborone, Botswana.
abstract: METHODS
  Gaborone, the capital of Botswana.
  
  
  OBJECTIVE
  To determine the time from positive sputum smear microscopy for acid-fast bacilli (AFB) to initiation of therapy, and to identify risk factors for delays.
  
  
  METHODS
  Retrospective cohort study of medical records and surveillance data for patients with positive smear microscopy and newly diagnosed tuberculosis (TB) from January to May 1997. Treatment delay was defined as more than 2 weeks from the first positive sputum smear to the initiation of TB treatment.
  
  
  RESULTS
  Of 127 patients identified, 15 (11.8%) had treatment delay, 13 (10.2%) had an incomplete workup (only one smear performed) and were not registered for TB treatment, and six (4.5%) had two or more positive smears but were not registered for TB treatment. Risk factors for treatment delay or non-registration included TB patients who had been diagnosed in a hospital outpatient setting vs. a clinic (RR 2.9, 95% CI 1.2-3.6, P = 0.02), or in a high volume vs. low volume clinic (RR 2.2, 95% CI 1.2-5.3, P = 0.01).
  
  
  CONCLUSIONS
  More than a quarter of the smear-positive TB patients identified had treatment delay or no evidence of treatment initiation. Proper monitoring of laboratory sputum results and suspect TB patient registers could potentially reduce treatment delays and patient loss.
authors.affiliation: The BOTUSA Project, Gaborone, Botswana.
authors.forename: T L
authors.initials: TL
authors.lastname: Creek
authors.forename: S
authors.initials: S
authors.lastname: Lockman
authors.forename: T A
authors.initials: TA
authors.lastname: Kenyon
authors.forename: M
authors.initials: M
authors.lastname: Makhoa
authors.forename: N
authors.initials: N
authors.lastname: Chimidza
authors.forename: T
authors.initials: T
authors.lastname: Moeti
authors.forename: B B
authors.initials: BB
authors.lastname: Sarpong
authors.forename: N J
authors.initials: NJ
authors.lastname: Binkin
authors.forename: J W
authors.initials: JW
authors.lastname: Tappero
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001902:Botswana; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012307:Risk Factors; D012698:Serologic Tests; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy*; D014850:Waiting Lists
chemical_list: D000995:Antitubercular Agents