From suspect to patient: tuberculosis diagnosis and treatment initiation in health facilities in South Africa.
METHODS
Thirteen primary health care (PHC) facilities in the Stellenbosch District, South Africa.


OBJECTIVE
To assess the use of a sputum register to evaluate the tuberculosis (TB) diagnostic process and the initiation of TB treatment in selected PHC facilities in a country with a centralised laboratory system.


METHODS
This prospective study was conducted between April 2004 and March 2005. The names of all individuals submitting sputum samples for TB testing were noted in a newly introduced sputum register. We classified all TB suspects with two positive smears as TB cases and consulted TB treatment registers until 3 months after sputum submission to determine how many had started treatment.


RESULTS
A total of 4062 persons aged > or =15 years submitted sputum samples, of whom 2484 were TB suspects. There were 2037 suspects with at least two results, 367 (18%) had at least two positive smears and 64 (17%) of these did not start treatment (initial defaulters). Over the entire diagnostic process, up to 5% of TB cases were missed, and up to 26% did not start treatment and were not reported.


CONCLUSIONS
By correcting diagnostic weaknesses identified in the sputum register, PHC facilities will be able to detect, treat and cure a higher percentage of TB patients.
Botha
E
E
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa. ebotha@sun.ac.za
den Boon
S
S
Lawrence
K-A
KA
Reuter
H
H
Verver
S
S
Lombard
C J
CJ
Dye
C
C
Enarson
D A
DA
Beyers
N
N
D000293:Adolescent; D000328:Adult; D005260:Female; D006268:Health Facilities; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D012042:Registries; D013019:South Africa; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy*