title: Diagnostic and treatment delays of multidrug-resistant tuberculosis before initiating treatment: a cross-sectional study.
abstract: OBJECTIVE
  Shandong Province has implemented the standardised treatment of multidrug-resistant tuberculosis (MDR-TB) supported by the Global Fund. The study aimed to understand the managements and delays of patients with MDR-TB before initiating their treatments.
  
  
  METHODS
  All patients with MDR-TB who had completed intensive phase treatment from January 2010 to May 2012 were interviewed using a structured questionnaire. Delays and treatments were analysed. Diagnosis delay is defined as the period between having sputum smear results and drug susceptibility test (DST) results. Treatment delay was defined as starting MDR-TB treatment more than 2 days after receiving the diagnosis of MDR-TB. Total delay is the sum of diagnosis delay and treatment delay.
  
  
  RESULTS
  In total, 110 patients with MDR-TB participated in the study. Median delay for diagnosis was 102 days. Over 80% of patients had a diagnosis delay longer than 90 days. MDR-TB treatments commenced after a median of 9 days after DST results, and over 37% of the patients with MDR-TB experienced treatment delays. Chronic cases or patients with indifferent attitude had significantly longer treatment delay than other groups (P = 0.03 and 0.03, respectively). During their delays, of 44 patients with retreatment failures, 12 (27.3%) were treated through adding single second line drugs (SLDs) to first-line regimens, and 25 (56.8%) were treated with first-line drugs. A high proportion of initial treatment failure/relapsed/returned cases (37%) and new cases (43%) were administered with SLDs.
  
  
  CONCLUSIONS
  Most of the patients with MDR-TB experienced prolonged diagnosis delay, which was the most important factor contributing to the total delay. Misuse of SLDs during the days was common, so necessary training should be given to prevent irrational prescription of medications.
authors.affiliation: Center for TB Control, Shandong Provincial Chest Hospital, Shandong, China.
authors.forename: Xiulei
authors.initials: X
authors.lastname: Zhang
authors.affiliation: School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Yin
authors.affiliation: Center for TB Control, Shandong Provincial Chest Hospital, Shandong, China.
authors.forename: Haitao
authors.initials: H
authors.lastname: Li
authors.affiliation: Center for TB Control, Shandong Provincial Chest Hospital, Shandong, China.
authors.forename: Shuguang
authors.initials: S
authors.lastname: Li
authors.affiliation: Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
authors.forename: John
authors.initials: J
authors.lastname: Walley
authors.affiliation: Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
authors.forename: Guanyang
authors.initials: G
authors.lastname: Zou
authors.affiliation: Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
authors.forename: Zhitong
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Wei
keywords: China; diagnosis delay; medicamentos de segunda línea; multidrug-resistant tuberculosis; médicaments de seconde ligne; retard de diagnostic; retard de traitement; retraso en el diagnóstico; retraso en el tratamiento; second-line drugs; treatment delay; tuberculose multirésistante; tuberculosis multirresistente