Abstract
BackgroundRecent approaches to TB control have focused on identifying and treating active cases to halt further transmission. Patients with TB symptoms often delay to seek care, get appropriate diagnosis, and initiate effective treatment. These delays are partly influenced by whom the patients contact within their community network. We aimed to evaluate the community drivers of diagnostic delay in an urban setting in Uganda.MethodsIn this study we analyze data from a retrospective cohort of 194 TB patients in Kampala, Uganda. We characterized the patterns of contacts made by patients seeking care for TB symptoms. The main outcome of interest was total community contact delay, defined as the time patients spent seeking care before visiting a provider capable of diagnosing TB.ResultsVisits to health providers without access to appropriate diagnostic services accounted for 56% of contacts made by cohort members, and were significantly associated with community contact delay, as were symptoms common to other prevalent illnesses, such as bone and joint pain.ConclusionsEducation programs aimed at primary care providers, as well as other community members, may benefit case identification, by informing them of rarer symptoms of TB, potential for co-infections of TB and other prevalent diseases, and the availability of diagnostic services.
Highlights
Recent approaches to TB control have focused on identifying and treating active cases to halt further transmission
While TB prevalence studies indicate that infected individuals may transmit tuberculosis bacilli before symptom onset [2], the majority of transmission occurs between the debut of symptoms and treatment initiation [3]
Patterns of community contact delay There were a total of 9014.69 days spent in the community contact period of the Diagnostic II cohort, with a median 33 days (IQR: 14–66.75) spent by each patient
Summary
Recent approaches to TB control have focused on identifying and treating active cases to halt further transmission. An extensive body of literature is dedicated to studies of delays at both the patient and healthcare system levels, in a variety of incidence or socio-economic settings These studies have reported numerous risk factors for delay, Mercaldo et al BMC Infectious Diseases (2021) 21:641 including comorbidities [7, 8], low access to healthcare [9,10,11], initial visits to low-level healthcare facilities with inadequate diagnostic abilities [12,13,14], age and sex [8, 15], and beliefs or misunderstandings about the disease [16,17,18]. These factors affect delay in one or more stages by increasing the duration of time spent 1) experiencing symptoms without seeking care, 2) searching for qualified practitioners, or 3) awaiting diagnosis following a visit to a qualified provider or facility
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