title: Are we doing enough to stem the tide of acquired MDR-TB in countries with high TB burden? Results of a mixed method study in Chongqing, China.
abstract: Multi-drug resistant tuberculosis (MDR-TB) represents a threat to health and development in countries with high TB burden. China's MDR-TB prevalence rate of 6.8% is the highest in the world. Interventions to remove barriers against effective TB control, and prevention of MDR-TB are urgently needed in the country. This paper reports a cross-sectional questionnaire survey of 513 pulmonary TB (PTB) patients, and qualitative interviews of 10 healthcare workers (HCWs), and 15 PTB patients. The objective was to assess barriers against effective control of PTB and prevention of MDR-TB by elucidating the perspectives of patients and healthcare providers. Results showed that more than half of the patients experienced patient delay of over 12.5 days. A similar proportion also experienced detection delay of over 30 days, and delay in initiating treatment of over 31 days. Consulting a non-TB health facility ≥3 times before seeking care at TB dispensary was a risk factor for both detection delay [AOR (95% CI): 1.89(1.07, 3.34) and delay in initiating treatment[AOR (95% CI): 1.88 (1.06, 3.36). Results revealed poor implementation of Directly Observed Therapy (DOT), whereby treatment of 34.3% patients was never monitored by HCWs. Only 31.8% patients had ever accessed TB health education before their TB diagnosis. Qualitative data consistently disclosed long patient delay, and indicated that patient's poor TB knowledge and socioeconomic barriers were primary reasons for patient delay. Seeking care and being treated at a non-TB hospital was an important reason for detection delay. Patient's long work hours and low income increased risk for treatment non-adherence. Evidence-based measures to improve TB health seeking behavior, reduce patient and detection delays, improve the quality of DOT, address financial and system barriers, and increase access to TB health promotion are urgently needed to address the burgeoning prevalence of MDR-TB in China.
authors: Department of Social Medicine and Health Service Management, Third Military Medical University, Chongqing, China.
authors: Ying
authors: Y
authors: Li
authors: Division of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, Tucson, Arizona, United States of America.
authors: John
authors: J
authors: Ehiri
authors: Division of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health University of Arizona, Tucson, Arizona, United States of America.
authors: Eyal
authors: E
authors: Oren
authors: Chongqing Institute of TB Prevention and Treatment, Jiulongpo District, Chongqing, China.
authors: Daiyu
authors: D
authors: Hu
authors: Department of TB control, Center of Disease Control in Shapingba District, Chongqing, China.
authors: Xingneng
authors: X
authors: Luo
authors: Department of Social Medicine and Health Service Management, Third Military Medical University, Chongqing, China.
authors: Ying
authors: Y
authors: Liu
authors: Department of Laboratory Medicine, University-Town Hospital of Chongqing Medical University, Chongqing, China.
authors: Daikun
authors: D
authors: Li
authors: Chongqing Institute of TB Prevention and Treatment, Jiulongpo District, Chongqing, China.
authors: Qingya
authors: Q
authors: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D018088:Tuberculosis, Multidrug-Resistant / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D014397:Tuberculosis, Pulmonary / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult