Prescribed and self-medication use increase delays in diagnosis of tuberculosis in the country of Georgia

Abstract

Setting: Georgia has a high burden of tuberculosis (TB), including multidrug-resistant TB. Enhancing early diagnosis of TB is a priority to reduce transmission.

Objective: To quantify delays in TB diagnosis and identify risk factors for delay in the country of Georgia.

Design: In a cross-sectional study, persons with newly diagnosed, culture-confirmed pulmonary TB were interviewed within 2 months of diagnosis and medical and laboratory records were abstracted.

Results: Among 247 persons enrolled, the mean and median total TB diagnostic delay was respectively 89.9 and 59.5 days. The mean and median patient delay was 56.2 and 23.5 days, while health care system delay was 33.7 and 14.0 days. In multivariable analysis, receipt of a medication prior to TB diagnosis was associated with increased overall diagnostic delay (adjusted odds ratio [aOR] 2.28, 95%CI 1.09-4.79); antibiotic use prior to diagnosis increased the risk of prolonged health care delay (aOR 4.16, 95%CI 1.97-8.79). TB cases who had increased patient-related diagnostic delay were less likely to have prolonged health care diagnostic delay (aOR 0.38, 95%CI 0.19-0.74).

Conclusion: Prolonged delays in detecting TB are common in Georgia. Interventions addressing the misuse of antibiotics and targeting groups at risk for prolonged delay are warranted to reduce diagnostic delays and enhance TB control.

Figure

Diagnostic and treatment delays in days. The mean total diagnostic delay was 89.9 days (median 59.5, IQR 28–124), including a patient component delay of 56.2 days (median 23.5, IQR 4–82) and health care system delay of 33.7 days (median 14.0, IQR 4–40). The mean treatment delay (time from diagnosis to initiation of treatment) was 1.45 days (median 0, IQR 0–1). ◆ Mean delay. * Outlier. Box represents IQR. IQR = interquartile range.