TB patient delay, diagnosis delay, and treatment among migrants in Shanghai in 2018- 2020: a mixed-methods study

Abstract

Abstract Background The relatively high TB incidence rate among internal migrants raises a major concern on TB control in China. This study examines TB patient delay, diagnosis delay, and treatment performance in Shanghai in 2018–2020 focusing on disparities between migrant and local TB patients. Methods This study employed mixed methods. We obtained TB register data in 2018–2020 from the TB information management system (TBIMS) in Shanghai to examine patient delay, diagnosis delay, and treatment completion by resident type. Qualitative interviews were conducted with TB administrators and community healthcare providers to understand factors associated with TB treatment for migrant and local patients. Results From 2018 to 2020, migrant TB patients accounted for 44.40% of total cases, with an average age of 34.50, compared to local patients averaging 55.82 years old. Overall, there was no significant difference in patient delay between migrant and local patients (18.47 days on average). 22.12% of migrants and 16.52% of locals experienced diagnosis delays exceeding 14 days, respectively. After adjusting for all variables, migrant patients (OR 1.30, 95%CI, 1.18–1.44) and initial care-seeking at general hospitals (OR 3.76, 95% CI 3.45–4.09) were associated with a higher probability of diagnosis delay. 93.9% of migrant patients and 89.4% of the local patients had a successful TB treatment without statistically significant difference after adjusting for all variables. Qualitative interviews revealed a standard approach to managing TB patients in Shanghai no matter their resident type. Young migrant patients who were able to maintain their jobs in Shanghai often had better treatment adherence. Despite more patients postponed seeking care due to fear of COVID-19 and inconvenient access to care in 2020, the COVID-19 epidemic had minimal impact on TB treatment for both groups attributed to community-based case management. Conclusions There were no significant differences in TB patient delay and treatment outcome by type of resident between 2018 and 2020 in Shanghai, but migrant patients were more likely to experience diagnosis delay. It should improve awareness and knowledge of TB among healthcare professionals at general hospitals to mitigate the risk of diagnosis delay.