Correlates of delayed pulmonary tuberculosis diagnosis among HIV-infected pulmonary tuberculosis suspects in a rural HIV clinic, South Africa
Date
2012-07-11
Authors
Boniface, Respicious Lwezimula
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Abstract
Title: Correlates of delayed pulmonary tuberculosis diagnosis among HIVinfected
pulmonary tuberculosis suspects in rural HIV clinic in South Africa
Background
South Africa is among the countries most heavily affected by Human
Immunodeficiency Virus (HIV) and tuberculosis. Delay in pulmonary tuberculosis
(PTB) diagnosis is more prevalent in HIV-positive patients and is one of the
factors associated with the high prevalence of co-infection in this population. This
study sought to determine factors associated with delayed PTB diagnosis among
HIV-infected PTB suspects attending an HIV/AIDS clinic in rural South Africa.
Methods
This was a secondary analysis of the data collected in a retrospective cohort
study conducted by Rural Aids and Development Action Research Programme
(RADAR). Data were collected using record review of patients assessed as PTB
suspects over 2 years from January 2006 to December 2007 at Rixile clinic. TB
diagnosis delay was defined as PTB diagnosis after 8 weeks (56 days) from the
date of first sputum for acid fast bacilli (AFB) collection, taking into account those
diagnosed by culture as it takes up to 8 weeks to culture mycobacterium
tuberculosis using Lowenstein Jensen method.
Results
PTB diagnosis delay was found in 78/162 (48.15%) of the participants with
subsequent TB diagnosis. Median delay was 55 days (IQR = 20 – 302). The
delay was between 1 to 30 days in 27/78 (34.62%) participants, between 31 to
180 days in 26/78 (33.33%) participants and 25/78 (32.05%) participants
remained undiagnosed for more than 180 days. Factors predicting PTB diagnosis
delay in multivariate analysis were older age > 40 years (adjusted OR 3.43
95%CI 1.38 – 8.55, p=0.008), high HIV viral-load (adjusted OR 3.13 95%CI 1.13
– 8.71, p=0.03) and being on Antiretroviraltherapy (ART) at the time of PTB
diagnosis (adjusted OR 4.19 95%CI 1.66 – 10.58, p=0.002).
Conclusion
There is a considerable delay from PTB suspicion to diagnosis in these rural HIVinfected
patients. Older patients, those with elevated viral load and those who are
on ART at the time of PTB diagnosis are at higher risk of PTB diagnosis delay.
Therefore active and collaborative efforts to reduce the PTB diagnosis delay are
very essential.
Description
M.Sc.(Epidemiology), Faculty of Health Sciences, University of the Witwatersrand, 2011