Delays in Diagnosis and Treatment of Multi-Drug Resistant Tuberculosis: Magnitude and Institutional Barriers in Tanzania

Abstract

Background: Multi-drug-resistant tuberculosis (MDR-TB) poses significant challenges in timely diagnosis and treatment due to various institutional barriers. Effective management of MDR-TB requires addressing these barriers to improve patient outcomes. This study aimed to assess the magnitude of delays in the diagnosis and treatment of MDR-TB and identify associated institutional barriers in Tanzania. Methodology: A descriptive cross-sectional survey was conducted at three major healthcare facilities: the Central Tuberculosis Reference Laboratory (CTRL), Kibong’oto National TB Hospital, and regional hospitals in Mwanza and Mbeya, from January to April 2017. A total of 200 MDR-TB patients were randomly selected from hospital records, and 12 key informants were purposively chosen. Quantitative data were collected using a modified WHO questionnaire, while qualitative data were obtained through key informant interviews. Data were analyzed using SPSS version 22 for quantitative analysis and NVivo software for qualitative analysis. Diagnostic delay was categorized based on a 21-day cutoff. Results: Of the 200 approached MDR-TB patients, 192 provided complete responses (96.0% response rate). The mean age of respondents was 39.52 years (SD 12.87). Diagnostic delays were observed in 72.40% of the patients. Factors associated with delays included multiple hospital visits before diagnosis, longer consultation turnaround times, lack of health education, delayed laboratory results, payment methods (cash vs. insurance), and distance to diagnostic centers. Qualitative data revealed misdiagnosis, inadequate counseling, frequent breakdowns of diagnostic equipment, and individual-level barriers as significant contributors to delays. Conclusions: The study found that a majority of MDR-TB patients experienced diagnostic delays, with multiple institutional and individual factors contributing to these delays. Addressing issues such as misdiagnosis, inadequate health education, and logistical barriers, along with improving diagnostic infrastructure and reducing financial and distance-related barriers, could enhance timely diagnosis and treatment of MDR-TB in Tanzania.