Consulting private health care providers aggravates treatment delay in urban South African tuberculosis patients

Van Wyk S.S.
Enarson D.A.
Beyers N.
Lombard C.
Hesseling A.C.
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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.
Diagnostic delay, Private sector, Public sector, Treatment delay, Tuberculosis, tuberculostatic agent, adult, article, attitude to health, controlled study, delayed diagnosis, female, health care access, health care personnel, health care system, health care utilization, help seeking behavior, human, Human immunodeficiency virus infection, lung tuberculosis, major clinical study, male, patient education, priority journal, private hospital, public health service, risk factor, South Africa, therapy delay, urban area
International Journal of Tuberculosis and Lung Disease