Completeness and timeliness of treatment initiation after laboratory diagnosis of tuberculosis in Gaborone, Botswana
OBJECTIVE: To determine the time from positive sputum smear microscopy for acid-fast bacilli (AFB) to initiation of therapy, and to identify risk factors for delays.
DESIGN: Retrospective cohort study of medical records and surveillance data for patients with positive smear microscopy and newly diagnosed tuberculosis (TB) from January to May 1997. Treatment delay was defined as more than 2 weeks from the first positive sputum smear to the initiation of TB treatment.
RESULTS: Of 127 patients identified, 15 (11.8%) had treatment delay, 13 (10.2%) had an incomplete workup (only one smear performed) and were not registered for TB treatment, and six (4.5%) had two or more positive smears but were not registered for TB treatment. Risk factors for treatment delay or non-registration included TB patients who had been diagnosed in a hospital out-patient setting vs. a clinic (RR 2.9, 95%CI 1.2–3.6, P = 0.02), or in a high volume vs. low volume clinic (RR 2.2, 95%CI 1.2–5.3, P = 0.01).
CONCLUSION: More than a quarter of the smear-positive TB patients identified had treatment delay or no evidence of treatment initiation. Proper monitoring of laboratory sputum results and suspect TB patient registers could potentially reduce treatment delays and patient loss.
Document Type: Regular Paper
Affiliations: 1: The BOTUSA Project, Gaborone, Botswana 2: Division of TB Elimination, National Centers for HIV/AIDS, STD and TB Prevention, Atlanta, Georgia, USA; and the Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 3: University of Botswana, Gaborone, Botswana 4: Epidemiology Unit, Ministry of Health, Government of Botswana, Gaborone, Botswana 5: Gaborone City Council, Gaborone, Botswana 6: Division of TB Elimination, National Centers for HIV/AIDS, STD and TB Prevention, Atlanta, Georgia, USA
Publication date: October 1, 2000
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