Abstract
BackgroundA delayed initiation of tuberculosis treatment results in high morbidity, mortality, and increased person-to-person transmissions. The aim of this study was to assess treatment delay and its associated factors among adult drug resistant tuberculosis patients in the Amhara Regional State, Ethiopia.MethodsAn institution based cross-sectional study was conducted on all adult drug resistant tuberculosis patients who initiated treatment from September 2010 to December 2017. Data were collected from patient charts, registration books, and computer databases using abstraction sheets. The data were entered using Epi-info version 7 and exported to SPSS version 20 for analysis. Summary statistics, like means, medians, and proportions were used to present it. Binary logistic regression was fitted; Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was also computed. Variables with p-value < 0.05 in the multi-variable logistic regression model was declared as significantly associated with treatment delay.ResultsThe median time to commence treatment after drug resistant tuberculosis diagnosis was 8 (IQR: 3–37) days. Being diagnosed by Line probe assay [AOR = 5.59; 95% CI: 3.48–8.98], Culture [AOR = 5.15; 95% CI: 2.53–10.47], and history of injectable anti-TB drugs [AOR = 2.12; 95% CI: 1.41–3.19] were associated with treatment delays.ConclusionTreatment delay was long, especially among patients diagnosed by Culture or LPA and those who had a prior history of injectable anti-TB drugs. That suggested that the need for universal accesses to rapid molecular diagnostic tests, such as Gene Xpert and the PMDT team were needed to promptly decide to minimize unnecessary delays.
Highlights
A delayed initiation of tuberculosis treatment results in high morbidity, mortality, and increased person-to-person transmissions
The odds of treatment delay among patient who had history of treatment with injectable anti-TB drugs were two times higher [Adjusted Odds Ratio (AOR) = 2.12; 95% Confidence Interval (CI): 1.41–3.19, P < 0.0001] compared with patients with no such history
This study showed the median time to initiate drug resistant tuberculosis treatment after a confirmed diagnosis was 8 days
Summary
A delayed initiation of tuberculosis treatment results in high morbidity, mortality, and increased person-to-person transmissions. The aim of this study was to assess treatment delay and its associated factors among adult drug resistant tuberculosis patients in the Amhara Regional State, Ethiopia. Effective TB prevention and control was achieved through early case detection and prompt treatment initiation [7]. Different evidences show that timely initiations of drug resistant tuberculosis treatments are of paramount importance for increasing favorable outcomes and halting person to person transmissions [8]. Delayed treatment initiation leads to increased morbidity, mortality, and the progression of the disease to severe and complicated forms [13,14,15]. Patients with cavitary lesions and high bacilli loads are associated with an increased primary form of drug resistant TB and rapid person-person transmissions [16]
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