SETTING: Gaborone, the capital of Botswana. OBJECTIVE: To determine the time from positive sputum smear microscopy for acid-fast bacilli (AFB) to initiation of therapy, and to identify risk factors for delays. DESIGN: Retrospective cohort study of medical records and surveillance data for patients with positive smear microscopy and newly diagnosed tuberculosis (TB) from January to May 1997. Treatment delay was defined as more than 2 weeks from the first positive sputum smear to the initiation of TB treatment. RESULTS: Of 127 patients identified, 15 (11.8%) had treatment delay, 13 (10.2%) had an incomplete workup (only one smear performed) and were not registered for TB treatment, and six (4.5%) had two or more positive smears but were not registered for TB treatment. Risk factors for treatment delay or non-registration included TB patients who had been diagnosed in a hospital outpatient setting vs. a clinic (RR 2.9, 95% CI 1.2-3.6, P = 0.02), or in a high volume vs. low volume clinic (RR 2.2, 95% CI 1.2-5.3, P = 0.01). CONCLUSION: More than a quarter of the smear-positive TB patients identified had treatment delay or no evidence of treatment initiation. Proper monitoring of laboratory sputum results and suspect TB patient registers could potentially reduce treatment delays and patient loss.
SETTING:Gaborone, the capital of Botswana. OBJECTIVE: To determine the time from positive sputum smear microscopy for acid-fast bacilli (AFB) to initiation of therapy, and to identify risk factors for delays. DESIGN: Retrospective cohort study of medical records and surveillance data for patients with positive smear microscopy and newly diagnosed tuberculosis (TB) from January to May 1997. Treatment delay was defined as more than 2 weeks from the first positive sputum smear to the initiation of TB treatment. RESULTS: Of 127 patients identified, 15 (11.8%) had treatment delay, 13 (10.2%) had an incomplete workup (only one smear performed) and were not registered for TB treatment, and six (4.5%) had two or more positive smears but were not registered for TB treatment. Risk factors for treatment delay or non-registration included TB patients who had been diagnosed in a hospital outpatient setting vs. a clinic (RR 2.9, 95% CI 1.2-3.6, P = 0.02), or in a high volume vs. low volume clinic (RR 2.2, 95% CI 1.2-5.3, P = 0.01). CONCLUSION: More than a quarter of the smear-positive TB patients identified had treatment delay or no evidence of treatment initiation. Proper monitoring of laboratory sputum results and suspect TB patient registers could potentially reduce treatment delays and patient loss.
Authors: Jlucian Davis; Achilles Katamba; Josh Vasquez; Erin Crawford; Asadu Sserwanga; Stella Kakeeto; Fred Kizito; Grant Dorsey; Saskia den Boon; Eric Vittinghoff; Laurence Huang; Francis Adatu; Moses R Kamya; Philip C Hopewell; Adithya Cattamanchi Journal: Am J Respir Crit Care Med Date: 2011-03-11 Impact factor: 21.405
Authors: Peter MacPherson; Rein M G J Houben; Judith R Glynn; Elizabeth L Corbett; Katharina Kranzer Journal: Bull World Health Organ Date: 2013-11-22 Impact factor: 9.408
Authors: Luis Eduardo Cuevas; Mohammed Ahmed Yassin; Najla Al-Sonboli; Lovett Lawson; Isabel Arbide; Nasher Al-Aghbari; Jeevan Bahadur Sherchand; Amin Al-Absi; Emmanuel Nnamdi Emenyonu; Yared Merid; Mosis Ifenyi Okobi; Juliana Olubunmi Onuoha; Melkamsew Aschalew; Abraham Aseffa; Greg Harper; Rachel Mary Anderson de Cuevas; Kristin Kremer; Dick van Soolingen; Carl-Michael Nathanson; Jean Joly; Brian Faragher; Stephen Bertel Squire; Andrew Ramsay Journal: PLoS Med Date: 2011-07-12 Impact factor: 11.069
Authors: Yara Voss De Lima; Denise Evans; Liesl Page-Shipp; Antonia Barnard; Ian Sanne; Colin N Menezes; Annelies Van Rie Journal: PLoS One Date: 2013-01-16 Impact factor: 3.240
Authors: Richard J Lessells; Graham S Cooke; Nuala McGrath; Mark P Nicol; Marie-Louise Newell; Peter Godfrey-Faussett Journal: Trials Date: 2013-06-12 Impact factor: 2.279