Consulting private health care providers aggravates treatment delay in urban South African tuberculosis patients
SETTING: An urban primary health care facility in Khayelitsha, South Africa. OBJECTIVES: To determine the difference in total tuberculosis (TB) treatment delay in patients who initially seek care at National TB Control Programme (NTP) facilities after the onset of TB-related symptoms, compared to patients who initially seek care from non-NTP health care practitioners (HCPs); and to describe the relative contributions of diagnostic, treatment initiation, patient and health system (HS) delay. DESIGN: A cross-sectional study of adult TB patients treated by the NTP. RESULTS: A total of 210 patients (median age 31 years) were enrolled from May to December 2009: 46% were male, and 58% were human immunodeficiency virus (HIV) infected. The median duration of total delay was 31 days, diagnostic delay 26, treatment initiation delay 0, patient delay 8 and HS delay 17 days. Initial visit to a non-NTP HCP was independently associated with total (P = 0.007), HS (P = 0.014) and diagnostic delays (P = 0.012). HIV infection was an independent risk factor for total (P = 0.047) and HS delay (P = 0.021); 27% of patients reported first going to a non-NTP HCP. CONCLUSION: Initial care sought from non-NTP HCPs was the main determinant of total, HS and diagnostic delays. Engagement and education of private HCPs is recommended. © 2011 The Union.