M Djibuti1,2, T Kasrashvili1, T Zurashvili1. 1. Partnership for Research and Action for Health, Tbilisi, Georgia. 2. KNCV Tuberculosis Foundation, The Hague, Netherlands.
Abstract
SETTING: One national and two regional tuberculosis (TB) hospitals in Georgia. OBJECTIVES: To define the factors associated with private primary health care (PPHC) provider delay in TB diagnosis and treatment. DESIGN: This was a cross-sectional study of data collected from consecutive patients with pulmonary TB from July 2015 to August 2016, complemented by qualitative data collected among PPHC providers/managers, TB patients and policy makers. RESULTS: PPHC provider delay (>2 weeks from the first medical consultation for TB symptoms to the initiation of TB treatment) occurred in 43.8% of 320 TB patients. Modifiable factors significantly associated with PPHC provider delay included receiving any non-specific treatment before diagnosis of TB (adjusted OR [aOR] 9.45, 95%CI 5.10-17.51), adequate knowledge of TB (aOR 0.35, 95%CI 0.12-0.99) and lower TB-related stigma (aOR 0.47, 95%CI 0.28-0.81). Inappropriate referral of presumptive TB patients to general health facilities for chest X-ray examination, often followed by misinterpretation of X-ray results in these facilities, might mislead PPHC providers to initiate presumptive TB patients on non-specific treatment. CONCLUSION: PPHC provider delay in TB diagnosis and treatment is common in Georgia, highlighting a need for targeted interventions to improve identification and referral of presumptive TB patients to specialised TB services and Xpert testing.
SETTING: One national and two regional tuberculosis (TB) hospitals in Georgia. OBJECTIVES: To define the factors associated with private primary health care (PPHC) provider delay in TB diagnosis and treatment. DESIGN: This was a cross-sectional study of data collected from consecutive patients with pulmonary TB from July 2015 to August 2016, complemented by qualitative data collected among PPHC providers/managers, TB patients and policy makers. RESULTS: PPHC provider delay (>2 weeks from the first medical consultation for TB symptoms to the initiation of TB treatment) occurred in 43.8% of 320 TB patients. Modifiable factors significantly associated with PPHC provider delay included receiving any non-specific treatment before diagnosis of TB (adjusted OR [aOR] 9.45, 95%CI 5.10-17.51), adequate knowledge of TB (aOR 0.35, 95%CI 0.12-0.99) and lower TB-related stigma (aOR 0.47, 95%CI 0.28-0.81). Inappropriate referral of presumptive TB patients to general health facilities for chest X-ray examination, often followed by misinterpretation of X-ray results in these facilities, might mislead PPHC providers to initiate presumptive TB patients on non-specific treatment. CONCLUSION: PPHC provider delay in TB diagnosis and treatment is common in Georgia, highlighting a need for targeted interventions to improve identification and referral of presumptive TB patients to specialised TB services and Xpert testing.
Authors: M Wang; J M Fitzgerald; K Richardson; C A Marra; V J Cook; J Hajek; R K Elwood; W R Bowie; F Marra Journal: Int J Tuberc Lung Dis Date: 2011-08 Impact factor: 2.373
Authors: P Tattevin; D Che; P Fraisse; C Gatey; C Guichard; D Antoine; M C Paty; E Bouvet Journal: Int J Tuberc Lung Dis Date: 2012-04 Impact factor: 2.373