Missed opportunities for tuberculosis diagnosis
OBJECTIVES: To estimate the proportion of incident TB cases that might have been detected earlier than the actual date of diagnosis if a test more sensitive than smear microscopy had been used at an earlier presentation episode.
METHOD: Retrospective cohort study in urban Peru, investigating health care facility interactions for symptoms suggestive of TB prior to TB diagnosis through patient interviews and a review of clinical records.
RESULTS: Of 212 participants enrolled, 58% had one or more clinical interactions prior to their diagnostic episode. Of those with a prior episode, the median number of episodes was three. The median delay to diagnosis from first presentation was 26 days.
CONCLUSION: There are clear missed opportunities for earlier TB diagnosis, delaying treatment initiation and continued spread of Mycobacterium tuberculosis to the community. The implementation of sensitive diagnostic tests appropriate to resource-poor settings should be given high priority.
Document Type: Regular Paper
Affiliations: 1: Brighton and Sussex University Hospitals National Health Service Trust, Royal Sussex County Hospital, Brighton, UK; Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK 2: Asociación Benéfica Prisma, San Miguel, Lima, Peru 3: Universidad Peruana Cayetano Heredia, Lima, Peru 4: Ministerio de Salud, Dirección de Salud II Lima Sur, Lima, Peru
Publication date: 2011-02-01
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