Abstract
BackgroundDelays in diagnosis and treatment initiation may allow the emergence of new cases by transmission to the community, and is one of the challenges facing programme management of drug resistance in Myanmar. This study aimed to explore delays in diagnosis and treatment initiation, and associated factors among patients with multidrug-resistant tuberculosis.MethodsA cross-sectional study was conducted at Yangon Regional Tuberculosis Centre, Myanmar. Data were collected by face-to-face interviews and treatment-card reviews of all adult patients who had registered and started treatment with the standard regimen from May to November, 2017. Delay time was categorized by using median cut-off and analyzed using SPSS version 23.0. Logistic regression analysis was performed to assess the relative impact of predictor variables on diagnosis and treatment delays.ResultsA total of 210 patients participated in this study. The median diagnosis delay was 9 days, IQR 3 (8–11) and 58.6% of the patients experienced a long diagnosis delay. Below middle school education (adjusted odds ratio [AOR] = 2.75, 95% CI = 1.22–6.21), non-permanent salaried employment (AOR = 3.03, 95% CI = 1.32–6.95), co-existing diabetes mellitus (AOR = 5.06, 95% CI = 1.97–13.01) and poor awareness (AOR = 2.99, 95% CI = 1.29–6.92) were independent predictors of long diagnosis delay. The median treatment delay was 13 days, IQR 9 (8–17) and 51% of the patients experienced long treatment delay. Age 31–50 years (AOR = 4.50, 95% CI = 1.47–13.97) and age > 50 years (AOR = 9.40, 95% CI = 2.55–34.83), history with MDR-TB patient (AOR = 3.16, 95% CI = 1.29–7.69), > 20 km away from a Regional TB Centre (AOR = 14.33, 95% CI = 1.91–107.64) and poor awareness (AOR = 4.62, 95% CI = 1.56–13.67) were independent predictors of long treatment delay.ConclusionsStrengthening comprehensive health education, enhancing treatment adherence counseling, providing more Xpert MTB/RIF machines, expanding decentralized MDR-TB treatment centers, ensuring timely sputum transportation, provision of a patient support package immediately after confirmation, and strengthening contact-tracing for all household contacts with MDR-TB patients and active tuberculosis screening were the most effective ways to shorten delays in MDR-TB diagnosis and treatment initiation.
Highlights
Delays in diagnosis and treatment initiation may allow the emergence of new cases by transmission to the community, and is one of the challenges facing programme management of drug resistance in Myanmar
In (Table 3), as the factors associated with delay in treatment initiation, the patients who were in age of 31–50 years (AOR = 4.50, 95% Confidence interval (CI) = 1.47–13.97), older than 50 years (AOR = 9.40, 95% confidence intervals (95% CI) = 2.55–34.83), those who had a history of contact with Multidrug-resistant tuberculosis (MDR-TB) patient (AOR = 3.16, 95% CI = 1.29–7.69), those who were living more than 20 km away from the Regional TB Center (AOR = 14.33, 95% CI = 1.91–107.64), and those who had poor awareness (AOR = 4.62, 95% CI = 1.56–13.67) were significantly associated with long treatment delay
The 13-day median treatment delay found in this study was longer than the median treatment delays of 5 to 10 days found in previous studies in China [26] and Bangladesh [21, 30]
Summary
Delays in diagnosis and treatment initiation may allow the emergence of new cases by transmission to the community, and is one of the challenges facing programme management of drug resistance in Myanmar. Delay in the treatment initiation allows transmission to others and new MDR-TB cases emerging in community [3]. The World Health Organization (WHO) recommended Xpert MTB/RIF test, a cartridgebased fully automated nucleic acid amplification test, for patients suspected to have MDR-TB and those with HIV-associated TB [5,6,7]. It can improve both MDR/ RR-TB and drug-sensitive TB case detection. Scaling up of diagnostic capacity and patient-centered care could provide to improve linkage of MDR diagnosis to initiation of treatment, a particular problem in low- and middle-income countries was waiting lists of confirmed MDR-TB patients who were waiting health system capacity to deliver treatment [4]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
