Mapping Patient Pathways in Tuberculosis Care: Insights From Gujarat and Jharkhand States of India.

Abstract

Tuberculosis (TB) continues to pose a significant public health challenge globally. Despite efforts to meet targets set by the End-TB Strategy, progress has been slow. Health-seeking practices that decide approaches to various sectors of healthcare providers result in inappropriate diagnosis and lack of awareness regarding available standard treatment, indicating inaccuracy in estimated incidences and underreporting. This study was designed to map the patient pathways for Persons with Tuberculosis (PwTB) from their initial point of contact through to diagnosis and treatment. It aimed to identify the socio-demographic characteristics and profiles of PwTB, as well as their choice of healthcare facilities, that influenced care-seeking behavior throughout the TB care cascade. A cross-sectional study was conducted from January to July 2022 in Jharkhand and Gujarat, India. Data were collected from 997 PwTB using a pre-designed structured questionnaire, covering socio-demographic profiles, TB profile of PwTB, and care-seeking behavior. The study analyzed the number and types of facilities visited, categorized the data, and used chi-square and binary logistic regression tests to identify significant associations. In a study of 965 TBpatients, 58.8% were male, and 61.3% were aged 18-40. Patients visited an average of two healthcare facilities, with significant associations found between age, occupation, comorbidity status, and facility switching (p < 0.005). Public health facilities were the primary point of care, with 91.4% using them for first consultations and 80.6% for treatment. Regression analysis highlighted significant predictors of care-seeking behavior, underscoring the need to enhance public healthcare infrastructure. Understanding patient pathways and the factors influencing care-seeking behavior is crucial for improving TB management. Strengthening public healthcare infrastructure and enhancing coordination between public and private sectors can reduce transitions and ensure timely and appropriate care.