Harrow Medical Centre, Noida, India.
PLoS One. 2012;7(8):e42458. doi: 10.1371/journal.pone.0042458. Epub 2012 Aug 6.
Revised National Tuberculosis Control Programme (RNTCP), Delhi, India.
To ascertain the number and sequence of providers visited by TB patients before availing treatment services from DOTS; to describe the duration between onset of symptoms to treatment.
A cross sectional, qualitative study. Information was gathered through in-depth interviews of TB patients registered during the month of Oct, 2012 for availing TB treatment under the Revised National TB Control Programme from four tuberculosis diagnosis and treatment centers in Delhi.
Out of the 114 patients who registered, 108 participated in the study. The study showed that informal providers and retail chemists were the first point of contact and source of clinical advice for two-third of the patients, while the rest sought medical care from qualified providers directly. Most patients sought medical care from more than two providers, before being diagnosed as TB. Female TB patients and patients with extra-pulmonary TB had long mean duration between onset of symptoms to initiation of treatment (6.3 months and 8.4 months respectively).
The pathways followed by TB patients, illustrated in this study, provide valuable lessons on the importance of different types of providers (both formal and informal) in the health system in a society like India and the delays in the diagnosis and treatment of tuberculosis.
印度德里修订国家结核病控制规划（RNTCP）。
确定结核病患者在接受直接督导下短程化疗（DOTS）治疗前就诊的提供者数量和顺序；描述症状出现到治疗开始的时间间隔。
横断面、定性研究。通过对 2012 年 10 月在德里四个结核病诊断和治疗中心登记接受修订国家结核病控制规划治疗的结核病患者进行深入访谈，收集了信息。
在登记的 114 名患者中，有 108 名参与了研究。研究表明，在三分之二的患者中，非正式提供者和零售药剂师是他们的第一个接触点和临床建议来源，而其余患者则直接向合格提供者寻求医疗服务。大多数患者在被诊断为结核病之前，已经向不止两个提供者寻求过医疗服务。女性结核病患者和肺外结核病患者的症状出现到开始治疗的平均时间较长（分别为 6.3 个月和 8.4 个月）。
本研究中描述的结核病患者所遵循的途径，为像印度这样的社会中医疗体系中不同类型的提供者（包括正式和非正式提供者）的重要性以及结核病的诊断和治疗延迟提供了有价值的经验教训。
