title: Prescribed and self-medication use increase delays in diagnosis of tuberculosis in the country of Georgia.
abstract: METHODS
  Georgia has a high burden of tuberculosis (TB), including multidrug-resistant TB. Enhancing early diagnosis of TB is a priority to reduce transmission.
  
  
  OBJECTIVE
  To quantify delays in TB diagnosis and identify risk factors for delay in the country of Georgia.
  
  
  METHODS
  In a cross-sectional study, persons with newly diagnosed, culture-confirmed pulmonary TB were interviewed within 2 months of diagnosis and medical and laboratory records were abstracted.
  
  
  RESULTS
  Among 247 persons enrolled, the mean and median total TB diagnostic delay was respectively  89.9 and 59.5 days. The mean and median patient delay was 56.2 and 23.5 days, while health care system delay was 33.7 and 14.0 days. In multivariable analysis, receipt of a medication prior to TB diagnosis was associated with increased overall diagnostic delay (adjusted odds ratio [aOR] 2.28,  95%CI 1.09-4.79); antibiotic use prior to diagnosis increased the risk of prolonged health care delay (aOR 4.16, 95%CI 1.97-8.79). TB cases who had increased patient-related diagnostic delay were less likely to have prolonged health care diagnostic delay (aOR 0.38, 95%CI 0.19-0.74).
  
  
  CONCLUSIONS
  Prolonged delays in detecting TB are common in Georgia. Interventions addressing the misuse of antibiotics and targeting groups at risk for prolonged delay are warranted to reduce diagnostic delays and enhance TB control.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA. alexander.rabin@gmail.com
authors.forename: A S
authors.initials: AS
authors.lastname: Rabin
authors.forename: G
authors.initials: G
authors.lastname: Kuchukhidze
authors.forename: E
authors.initials: E
authors.lastname: Sanikidze
authors.forename: R R
authors.initials: RR
authors.lastname: Kempker
authors.forename: H M
authors.initials: HM
authors.lastname: Blumberg
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D005846:Georgia (Republic) / Q000453:epidemiology; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D055553:Prescription Drugs / Q000627:therapeutic use*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012651:Self Medication / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents; D055553:Prescription Drugs