TB treatment delays and associated risk factors in Dushanbe, Tajikistan, 2019-2021.

Autor: Sharifov R; Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.; Municipal Disinfection Station, Dushanbe, Tajikistan.; Central Asia Advanced Field Epidemiology Training Program, Almaty, Kazakhstan., Nabirova D; Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.; Central Asia Advanced Field Epidemiology Training Program, Almaty, Kazakhstan.; Central Asia Office, U.S. Centers for Disease Control and Prevention, Almaty, Kazakhstan., Tilloeva Z; Municipal Disinfection Station, Dushanbe, Tajikistan.; Central Asia Advanced Field Epidemiology Training Program, Almaty, Kazakhstan.; Avicenna Tajik State Medical University, Dushanbe, Tajikistan., Zikriyarova S; Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan., Kishore N; Global Immunizations Division, U.S. Centers for Disease Control and Prevention, Atlanta, USA., Jafarov N; Ministry of Health and Social Protection of the Republic of Tajikistan, Dushanbe, Tajikistan., Yusufi S; Ministry of Health and Social Protection of the Republic of Tajikistan, Dushanbe, Tajikistan., Horth R; Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan. hxw5@cdc.gov.; Central Asia Advanced Field Epidemiology Training Program, Almaty, Kazakhstan. hxw5@cdc.gov.; Central Asia Office, U.S. Centers for Disease Control and Prevention, Almaty, Kazakhstan. hxw5@cdc.gov.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2024 Dec 18; Vol. 24 (1), pp. 1398. Date of Electronic Publication: 2024 Dec 18.
DOI: 10.1186/s12879-024-10265-8
Abstrakt: Background: In Tajikistan, where there are about 8,000 cases annually, many new cases are being diagnosed with severe disease, indicating a delay in receiving care. We aimed to estimate the proportion with delayed care and the main factors contributing to delayed care.
Methods: Using a retrospective cohort design, we conducted a study that included all people aged over 15 years who were newly diagnosed with pulmonary TB in Dushanbe from 2019 to 2021. We defined 'patient delay' as > 14 days from TB symptom onset to the first provider visit and 'provider delay' as > 3 days from the first visit to treatment initiation. Data was abstracted from medical records and participants were interviewed in-person. Multivariable negative binomial regression was used to estimate adjusted risk ratios (aRR) and 95% confidence intervals (CI).
Results: Of 472 participants, 49% were male, 65% had lung tissue cavitation, 33% had drug resistant TB, 11% had diabetes, 4% had HIV, and. Reported cases dropped from 196 in 2019 to 109 in 2020 and increased to 167 in 2021. The proportion of people experiencing patient delays was 82%, 72%, and 90% per year, respectively. The proportion of provider delays was 44%, 41% and 29% per year. Patient delay was associated with year (aRR: 1.09 [CI:1.02-1.18] in 2021 vs. 2019), age (aRR:0.91 [0.82-0.99] for 40-59-year-olds vs. 15-39-year-olds), having HIV (aRR:1.22 [1.08-1.38]), having blood in sputum (aRR:1.19 [1.10-1.28]), chest pain (aRR:1.32 [1.14-1.54]), having at least two structural barriers vs. none (aRR:1.52 [1.28-1.80]), having one of the following barriers: long wait lines (aRR:1.36 [1.03-1.80]), feeling that healthcare services were expensive (aRR:1.54 [1.28-1.85]), or having no time or too much work (aRR:1.54 [1.29-1.84]). Provider delay was associated with year (aRR: 0.67 [0.51-0.89] in 2021 vs. 2019), patients having to pay for X-ray services (aRR: 1.59 [1.22-2.07]) and lacking direct-observed-therapy (DOTS) in facility (aRR: 1.61 [1.03-2.52]).
Conclusions: Patient delay was high before the COVID-19 pandemic and increased in 2021, while provider delay decreased during this time. Addressing structural barriers to healthcare services, such as increased DOTS facilities, expanded hours, and zero fees, may decrease delays.
Competing Interests: Declarations. Ethics approval and consent to participate: Our study was conducted in accordance the Declaration of Helsinki. Ethical approval for the study was received from the local ethical commission of the Asfendiyarov Kazakh National Medical University, Kazakhstan (No. 6 (129), 05/25/2022) and the Ministry of Health of Tajikistan. This activity was reviewed by the CDC and was determined to be non-research and conducted consistently with applicable U.S. federal law and CDC policy (45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. 241(d); 5 U.S.C. § 552a; 44 U.S.C. 3501 et seq.). Clinical trial number: not applicable. Informed consent was obtained from all participants, oral consent was obtained for participants interviewed virtually and written consent for those interviewed in-person. Written informed consent was obtained from parents of participants ages 15–17 years old who also provided verbal assent for participation. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention.
(© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
Databáze: MEDLINE
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