title: Pathways and costs of care for patients with tuberculosis symptoms in rural Uganda.
abstract: METHODS
  Six district-level government health centers in rural Uganda and the surrounding communities.
  
  
  OBJECTIVE
  To determine pathways to care and associated costs for patients with chronic cough referred for tuberculosis (TB) evaluation in Uganda.
  
  
  METHODS
  We conducted a cross-sectional study, surveying 64 patients presenting with chronic cough and undergoing first-time sputum evaluation at government clinics. We also surveyed a random sample of 114 individuals with chronic cough in surrounding communities. We collected information on previous health visits for the cough as well as costs associated with the current visit.
  
  
  RESULTS
  Eighty per cent of clinic patients had previously sought care for their cough, with a median of three previous visits (range 0-32, interquartile range [IQR] 2-5). Most (n = 203, 88%) visits were to a health facility that did not provide TB microscopy services, and the majority occurred in the private sector. The cost of seeking care for the current visit alone represented 28.8% (IQR 9.1-109.5) of the patients' median monthly household income.
  
  
  CONCLUSIONS
  Most patients seek health care for chronic cough, but do so first in the private sector. Engagement of the private sector and streamlining TB diagnostic evaluation are critical for improving case detection and meeting global TB elimination targets.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, USA; Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA.
authors.forename: P B
authors.initials: PB
authors.lastname: Shete
authors.affiliation: Infectious Diseases Research Collaboration, Kampala, Uganda.
authors.forename: P
authors.initials: P
authors.lastname: Haguma
authors.affiliation: Infectious Diseases Research Collaboration, Kampala, Uganda.
authors.forename: C R
authors.initials: CR
authors.lastname: Miller
authors.affiliation: Infectious Diseases Research Collaboration, Kampala, Uganda.
authors.forename: E
authors.initials: E
authors.lastname: Ochom
authors.affiliation: Infectious Diseases Research Collaboration, Kampala, Uganda.
authors.forename: I
authors.initials: I
authors.lastname: Ayakaka
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, USA; Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Davis
authors.affiliation: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Dowdy
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, USA; Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA.
authors.forename: P
authors.initials: P
authors.lastname: Hopewell
authors.affiliation: Infectious Diseases Research Collaboration, Kampala, Uganda; School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: A
authors.initials: A
authors.lastname: Katamba
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, USA; Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA.
authors.forename: A
authors.initials: A
authors.lastname: Cattamanchi
mesh_terms: D000328:Adult; D003371:Cough / Q000382:microbiology / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration*; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D014454:Uganda