title: Consulting private health care providers aggravates treatment delay in urban South African tuberculosis patients.
abstract: METHODS
  An urban primary health care facility in Khayelitsha, South Africa.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa. susanvanwyk@sun.ac.za
authors: S S
authors: SS
authors: Van Wyk
authors: D A
authors: DA
authors: Enarson
authors: N
authors: N
authors: Beyers
authors: C
authors: C
authors: Lombard
authors: A C
authors: AC
authors: Hesseling
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000706:statistics & numerical data*; D017149:Private Sector / Q000706:statistics & numerical data*; D017150:Public Sector / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D019037:Urban Health Services / Q000706:statistics & numerical data*
chemical_list: D000995:Antitubercular Agents