Correlates of delayed pulmonary tuberculosis diagnosis among HIV-infected pulmonary tuberculosis suspects in a rural HIV clinic, South Africa

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.