title: Confusion, caring and tuberculosis diagnostic delay in Cape Town, South Africa.
abstract: OBJECTIVE
  To explore the ways in which provider and patient behaviours interact to exacerbate diagnostic delay in Cape Town, South Africa.
  
  
  METHODS
  Eight focus group discussions were conducted in four urban communities, all with high tuberculosis (TB) prevalence, including two with high human immunodeficiency virus co-prevalence. Groups were stratified by sex, ethnicity and TB status. Findings were elicited inductively from the dataset using a combination of grounded theory and thematic analysis.
  
  
  RESULTS
  Diagnostic delay was caused by delays in care seeking, provider failure to diagnose TB at first contact, use of the private sector which did not treat TB and multiple care seeking within and between sectors.
  
  
  CONCLUSIONS
  Patient behaviour interacts with institutional arrangements in a way that materially exacerbates TB diagnostic delay. Care seeking in pluralistic settings needs to be understood as a complex process involving a range of providers across sectors. Strategies to smooth the flow of patients within and between sectors and improve perceptions of both service quality and levels of privacy will reduce diagnostic delays and improve both the efficiency and the effectiveness of the current TB treatment programme.
authors.affiliation: Centre for International Health and Development, University College London Institute for Child Health, London, UK. j.skordis-worrall@ucl.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Skordis-Worrall
authors.forename: K
authors.initials: K
authors.lastname: Hanson
authors.forename: A
authors.initials: A
authors.lastname: Mills
mesh_terms: D000328:Adult; D057210:Delayed Diagnosis; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D019037:Urban Health Services / Q000592:standards; D055815:Young Adult