Causes of Late Diagnosis of Tuberculosis in HIV Patients

Abstract

The objective: to determine causes of frequent detection of disseminated tuberculosis in HIV-infected patients taking into account the behavioral characteristics of patients, to propose additional measures to enhance tuberculosis detection.Subjects and Methods. 108 questionnaires filled out by TB/HIV co-infected patients staying in specialized hospitals in 3 regions of the Russian Federation were studied. We filled out the first 18 questionnaires ourselves while talking to patients, to assess whether the questions were clear to patients. The questionnaire included 28 questions with prompted answers; in addition, patients could give their own answers. Using the questionnaire, we found out whether the patients were seeking medical help in a timely manner, units to which they referred, awareness of tuberculosis before developing it, and exposure to tuberculous infection.Results. The majority of interviewed patients with previously diagnosed HIV infection did not undergo medical examination at the Center for AIDS Prevention and Control (CAIDSPC). When complaints associated with tuberculosis appeared, 57/108 (52.8%) respondents referred to the clinic at their place of residence. In 56/108 (51.8%) patients, 2 or more months passed from the moment of referral for medical help to diagnosis and initiation of tuberculosis treatment. 7/108 (6.5%) respondents reported history of tuberculosis, and 4/108 (3.7%) respondents reported exposure to a tuberculosis patient. After developing tuberculosis, 20/108 (18.5%) respondents were exposed to other HIV-infected patients. After detection of HIV infection, 93 (86.1%) patients indicated that they had not been made aware of tuberculosis.