title: The effect of diagnostic delays on the drop-out rate and the total delay to diagnosis of tuberculosis.
abstract: BACKGROUND
  Numerous patient and healthcare system-related delays contribute to the overall delay experienced by patients from onset of TB symptoms to diagnosis and treatment. Such delays are critical as infected individuals remain untreated in the community, providing more opportunities for transmission of the disease and adversely affecting the epidemic.
  
  
  RESULTS
  We present an analysis of the factors that contribute to the overall delay in TB diagnosis and treatment, in a resource-poor setting. Impact on the distribution of diagnostic delay times was assessed for various factors, the sensitivity of the diagnostic method being found to be the most significant. A linear relationship was found between the sensitivity of the test and the predicted mean delay time, with an increase in test sensitivity resulting in a reduced mean delay time and a reduction in the drop-out rate.
  
  
  CONCLUSIONS
  The results show that in a developing country a number of delay factors, particularly the low sensitivity of the initial sputum smear microscopy test, potentially increase total diagnostic delay times experienced by TB patients significantly. The results reinforce the urgent need for novel diagnostic methods, both for smear positive and negative TB, that are highly sensitive, accessible and point of care, in order to reduce mean delay times.
authors.affiliation: DST/NRF Centre of Excellence for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Western Cape, Republic of South Africa.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Millen
authors.forename: Pieter W
authors.initials: PW
authors.lastname: Uys
authors.forename: John
authors.initials: J
authors.lastname: Hargrove
authors.forename: Paul D
authors.initials: PD
authors.lastname: van Helden
authors.forename: Brian G
authors.initials: BG
authors.lastname: Williams
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D003153:Community Health Services / Q000458:organization & administration; D003198:Computer Simulation; D003906:Developing Countries; D006297:Health Services Accessibility; D006801:Humans; D010342:Patient Acceptance of Health Care; D011336:Probability; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000635:transmission*
chemical_list: D000995:Antitubercular Agents