Abstract
Background
Delays in seeking and accessing treatment for rifampicin-resistant tuberculosis (RR-TB) and multi-drug resistant (MDR-TB) are major impediments to TB control in high-burden, resource-limited settings.
Method
We prospectively determined health-seeking behavioural patterns and associations with treatment outcomes and costs among 68 RR-TB patients attending conveniently selected facilities in a decentralised system in Harare, Zimbabwe.
Results
From initial symptoms to initiation of effective treatment, patients made a median number of three health care visits (IQR 2–4 visits) at a median cost of 13% (IQR 6–31%) of their total annual household income (mean cost, US$410). Cumulatively, RR-TB patients most frequently first visited private facilities, i.e., private pharmacies (30%) and other private health care providers (24%) combined. Median patient delay was 26 days (IQR 14–42 days); median health system delay was 97 days (IQR 30–215 days) and median total delay from symptom onset to initiation of effective treatment was 132 days (IQR 51–287 days). The majority of patients (88%) attributed initial delay in seeking care to “not feeling sick enough.” Total delay, total cost and number of health care visits were not associated with treatment or clinical outcomes, though our study was not adequately powered for these determinations.
Conclusions
Despite the public availability of rapid molecular TB tests, patients experienced significant delays and high costs in accessing RR-TB treatment. Active case finding, integration of private health care providers and enhanced service delivery may reduce treatment delay and TB associated costs.
Funder
National Institutes of Health
Robert Wood Johnson Foundation
Fogarty International Center
Publisher
Public Library of Science (PLoS)
Reference42 articles.
1. World Health Organization. Global Tuberculosis Report 2020. Geneva2020.
2. Risk factors for catastrophic costs associated with tuberculosis in rural South Africa;N Stracker;The International Journal of Tuberculosis and Lung Disease,2019
3. Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa–a systematic review;DM Barter;BMC public health,2012
4. Drug-resistant tuberculosis in South Africa: history, progress and opportunities for achieving universal access to diagnosis and effective treatment;H Cox;South African Health Review,2017
5. The economic burden of tuberculosis care for patients and households in Africa: a systematic review;K Ukwaja;The International Journal of Tuberculosis and Lung Disease,2012