Abstract
BackgroundBangladesh is one of the 27 high burden countries for multidrug resistant tuberculosis listed by the World Health Organization. Delay in multidrug resistant tuberculosis treatment may allow progression of the disease and affect the attempts to curb transmission of drug resistant tuberculosis. The main objective of this study was to investigate the health system delay in multidrug resistant tuberculosis treatment in Bangladesh and to explore the factors related to the delay.MethodsInformation related to the delay was collected as part of a previously conducted case–control study. The current study restricts analysis to patients with multidrug resistant tuberculosis who were diagnosed using rapid diagnostic methods (Xpert MTB/RIF or the line probe assay). Information was collected by face-to-face interviews and through record reviews from all three Government hospitals providing multidrug resistant tuberculosis services, from September 2012 to April 2013. Multivariable regression analysis was performed using Bootstrap variance estimators. Definitions were as follows: Provider delay: time between visiting a provider for first consultation on MDR-TB related symptom to visiting a designated diagnostic centre for testing; Diagnostic delay: time from date of diagnostic sample provided to date of result; Treatment initiation delay: time between the date of diagnosis and date of treatment initiation; Health system delay: time between visiting a provider to start of treatment. Health system delay was derived by adding provider delay, diagnostic delay and treatment initiation delay.ResultsThe 207 multidrug resistant tuberculosis patients experienced a health system delay of median 7.1 weeks. The health system delay consists of provider delay (median 4 weeks), diagnostic delay (median 5 days) and treatment initiation delay (median 10 days). Health system delay (Coefficient: 37.7; 95 %; CI 15.0–60.4; p 0.003) was associated with the visit to private practitioners for first consultation.ConclusionsDiagnosis time for multidrug resistant tuberculosis was fast using the rapid tests. However, some degree of delay was present in treatment initiation, after diagnosis. The most effective way to reduce health system delay would be through strategies such as engaging private practitioners in multidrug resistant tuberculosis control.
Highlights
Bangladesh is one of the 27 high burden countries for multidrug resistant tuberculosis listed by the World Health Organization
Our study aims to explore delays related to the commencement of treatment for Multidrug resistant tuberculosis (MDR-TB) patients caused by the health system, namely provider delay, diagnostic delay and treatment initiation delay
Study population and setting MDR-TB patients were identified as part of a previously conducted case–control study on risk factors associated with MDR-TB in Bangladesh when information related to treatment delay was collected [28]
Summary
Bangladesh is one of the 27 high burden countries for multidrug resistant tuberculosis listed by the World Health Organization. Delay in multidrug resistant tuberculosis treatment may allow progression of the disease and affect the attempts to curb transmission of drug resistant tuberculosis. Multidrug resistant tuberculosis (MDR-TB) is a major challenge to worldwide tuberculosis (TB) control [1]. Due to the overall high TB burden in Bangladesh, the proportion of patients with MDR-TB (1.4 % and 29 %, among the new and previously treated TB patients, respectively) amounts to 4700 people (2100 and 2600 among new and previously treated TB patients, respectively), which provides a significant challenge for the national tuberculosis control programme [2]
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