Factors associated with delays in treatment initiation after tuberculosis diagnosis in two districts of India.
BACKGROUND
Excessive time between diagnosis and initiation of tuberculosis (TB) treatment contributes to ongoing TB transmission and should be minimized. In India, Revised National TB Control Programme (RNTCP) focuses on indicator start of treatment within 7 days of diagnosis for patients with sputum smear-positive PTB for monitoring DOTS implementation.


OBJECTIVE
To determine length of time between diagnosis and initiation of treatment and factors associated with delays of more than 7 days in smear-positive pulmonary TB.


METHODS
Using existing programme records such as the TB Register, treatment cards, and the laboratory register, we conducted a retrospective cohort study of all patients with smear-positive pulmonary TB registered from July-September 2010 in two districts in India. A random sample of patients with pulmonary TB who experienced treatment delay of more than 7 days was interviewed using structured questionnaire.


RESULTS
2027 of 3411 patients registered with pulmonary TB were smear-positive. 711(35%) patients had >7 days between diagnosis and treatment and 262(13%) had delays >15 days. Mean duration between TB diagnosis and treatment initiation was 8 days (range = 0-128 days). Odds of treatment delay >7 days was 1.8 times more likely among those who had been previously treated (95% confidence interval [CI] 1.5-2.3) and 1.6 (95% CI 1.3-1.8) times more likely among those diagnosed in health facilities without microscopy centers. The main factors associated with a delay >7 days were: patient reluctance to start a re-treatment regimen, patients seeking second opinions, delay in transportation of drugs to the DOT centers and delay in initial home visits. To conclude, treatment delay >7 days was associated with a number of factors that included history of previous treatment and absence of TB diagnostic services in the local health facility. Decentralized diagnostic facilities and improved referral procedures may reduce such treatment delays.
Office of the WHO-Representative in India, World Health Organization (WHO), New Delhi, India. pauld@rntcp.org
Durba
D
Paul
Arundhathi
A
Busireddy
Sharath Burugina
SB
Nagaraja
Srinath
S
Satyanarayana
Puneet Kumar
PK
Dewan
Sreenivas Achutan
SA
Nair
Silajit
S
Sarkar
Quazi Toufique
QT
Ahmed
Shakuntala
S
Sarkar
Sreenivas Rao Motta
SR
Shamrao
Anthony David
AD
Harries
John Ethan
JE
Oeltmann
D000328:Adult; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult