title: Durations and Delays in Care Seeking, Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai, India.
abstract: BACKGROUND
  Timely diagnosis and treatment initiation are critical to reduce the chain of transmission of Tuberculosis (TB) in places like Mumbai, where almost 60% of the inhabitants reside in overcrowded slums. This study documents the pathway from the onset of symptoms suggestive of TB to initiation of TB treatment and examines factors responsible for delay among uncomplicated pulmonary TB patients in Mumbai.
  
  
  METHODS
  A population-based retrospective survey was conducted in the slums of 15 high TB burden administrative wards to identify 153 self-reported TB patients. Subsequently in-depth interviews of 76 consenting patients that fit the inclusion criteria were undertaken using an open-ended interview schedule. Mean total, first care seeking, diagnosis and treatment initiation duration and delays were computed for new and retreatment patients. Patients showing defined delays were divided into outliers and non-outliers for all three delays using the median values.
  
  
  RESULTS
  The mean duration for the total pathway was 65 days with 29% of patients being outliers. Importantly the mean duration of first care seeking was similar in new (24 days) and retreatment patients (25 days). Diagnostic duration contributed to 55% of the total pathway largely in new patients. Treatment initiation was noted to be the least among the three durations with mean duration in retreatment patients twice that of new patients. Significantly more female patients experienced diagnostic delay. Major shift of patients from the private to public sector and non-allopaths to allopaths was observed, particularly for treatment initiation.
  
  
  CONCLUSIONS
  Achieving positive behavioural changes in providers (especially non-allopaths) and patients needs to be considered in TB control strategies. Specific attention is required in counselling of TB patients so that timely care seeking is effected at the time of relapse. Prioritizing improvement of environmental health in vulnerable locations and provision of point of care diagnostics would be singularly effective in curbing pathway delays.
authors.affiliation: The Foundation for Medical Research, 84A, R. G. Thadani Marg, Worli, Mumbai, India.
authors.forename: Nerges
authors.initials: N
authors.lastname: Mistry
authors.affiliation: The Foundation for Medical Research, 84A, R. G. Thadani Marg, Worli, Mumbai, India.|Maharashtra Association of Anthropological Sciences-Centre for Health Research and Development, Savitribai Phule University, Pune, Maharashtra, India.
authors.forename: Sheela
authors.initials: S
authors.lastname: Rangan
authors.affiliation: The Foundation for Medical Research, 84A, R. G. Thadani Marg, Worli, Mumbai, India.
authors.forename: Yatin
authors.initials: Y
authors.lastname: Dholakia
authors.affiliation: The Foundation for Medical Research, 84A, R. G. Thadani Marg, Worli, Mumbai, India.
authors.forename: Eunice
authors.initials: E
authors.lastname: Lobo
authors.affiliation: The Foundation for Medical Research, 84A, R. G. Thadani Marg, Worli, Mumbai, India.
authors.forename: Shimoni
authors.initials: S
authors.lastname: Shah
authors.affiliation: The Foundation for Medical Research, 84A, R. G. Thadani Marg, Worli, Mumbai, India.
authors.forename: Akshaya
authors.initials: A
authors.lastname: Patil
mesh_terms: D000293:Adolescent; D000328:Adult; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007194:India; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012189:Retrospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000523:psychology; D055815:Young Adult