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Free Content How do patients access the private sector in Chennai, India? An evaluation of delays in tuberculosis diagnosis

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SETTING: The diagnosis and treatment of tuberculosis (TB) in India are characterized by heavy private-sector involvement. Delays in treatment remain poorly characterized among patients seeking care in the Indian private sector.

OBJECTIVE: To assess delays in TB diagnosis and treatment initiation among patients diagnosed in the private sector, and pathways to care in an urban setting.

DESIGN: Cross-sectional survey of 289 consecutive patients diagnosed with TB in the private sector and referred for anti-tuberculosis treatment through a public-private mix program in Chennai from January 2014 to February 2015.

RESULTS: Among 212 patients with pulmonary TB, 90% first contacted a formal private provider, and 78% were diagnosed by the first or second provider seen after a median of three visits per provider. Median total delay was 51 days (mean 68). Consulting an informal (rather than formally trained) provider first was associated with significant increases in total delay (absolute increase 22.8 days, 95%CI 6.2–39.5) and in the risk of prolonged delay >90 days (aRR 2.4, 95%CI 1.3–4.4).

CONCLUSION: Even among patients seeking care in the formal (vs. informal) private sector in Chennai, diagnostic delays are substantial. Novel strategies are required to engage private providers, who often serve as the first point of contact.
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Keywords: care-seeking behavior; diagnostic testing; patient pathways; transmission

Document Type: Research Article

Affiliations: 1: *Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA 2: REACH, Chennai, India 3: §McGill International TB Centre & Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada 4: *Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA

Publication date: April 1, 2016

More about this publication?
  • 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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