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Free Content Confusion, caring and tuberculosis diagnostic delay in Cape Town, South Africa

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OBJECTIVE: To explore the ways in which provider and patient behaviours interact to exacerbate diagnostic delay in Cape Town, South Africa.

DESIGN: Eight focus group discussions were conducted in four urban communities, all with high tuberculosis (TB) prevalence, including two with high human immunodeficiency virus co-prevalence. Groups were stratified by sex, ethnicity and TB status. Findings were elicited inductively from the dataset using a combination of grounded theory and thematic analysis.

RESULTS: Diagnostic delay was caused by delays in care seeking, provider failure to diagnose TB at first contact, use of the private sector which did not treat TB and multiple care seeking within and between sectors.

CONCLUSION: Patient behaviour interacts with institutional arrangements in a way that materially exacerbates TB diagnostic delay. Care seeking in pluralistic settings needs to be understood as a complex process involving a range of providers across sectors. Strategies to smooth the flow of patients within and between sectors and improve perceptions of both service quality and levels of privacy will reduce diagnostic delays and improve both the efficiency and the effectiveness of the current TB treatment programme.
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Keywords: HIV; South Africa; diagnostic delay; health seeking behaviour; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Centre for International Health and Development, University College London Institute for Child Health, London, UK; and London School of Hygiene & Tropical Medicine, London, UK 2: London School of Hygiene & Tropical Medicine, London, UK

Publication date: 01 February 2010

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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