Perinatal HIV Research Unit, Tshepong Hospital and University of the Witwatersrand, Johannesburg, South Africa.
Int J Tuberc Lung Dis. 2013 Sep;17(9):1199-205. doi: 10.5588/ijtld.12.0891.
In South Africa, the majority of tuberculosis (TB) patients are co-infected with the human immunodeficiency virus (HIV), and delays in diagnosis and treatment likely exacerbate morbidity and mortality.
To determine predictors of delays in the diagnosis and treatment of hospitalised suspected pulmonary TB patients co-infected with HIV.
Post-analysis of data collected in a three-centre prospective cohort of in-patients clinically diagnosed with active TB in three hospitals in South Africa between 2006 and 2009 during the first 24 h of admission. Delay was assessed by asking time of first symptoms and any prior health-seeking behaviour for this episode of illness.
Data from a total of 891 participants with a median age of 36 years and a CD4 count of 67 cells/mm(3) were analysed. Median patient, system and total delays were respectively 28, 1 and 28 days. Unemployment, treatment at Tshepong Hospital, alcohol consumption, crowding index, seeking prior treatment, cotrimoxazole treatment and WHO Stage 4 disease predicted prolonged total delay.
Patient delay in seeking care for TB in this high HIV prevalence setting is substantial. Factors identified with delay could be used to develop interventions to improve care seeking and earlier diagnosis of TB.
在南非，大多数肺结核（TB）患者同时感染了人类免疫缺陷病毒（HIV），而诊断和治疗的延迟可能会加剧发病率和死亡率。
确定同时感染 HIV 的住院疑似肺结核（TB）患者在诊断和治疗方面出现延迟的预测因素。
对 2006 年至 2009 年期间在南非的三家医院中，891 名患有活动期 TB 的住院患者的前瞻性队列研究数据进行的事后分析。通过询问首次出现症状的时间和本次疾病发作之前的任何先前的寻医行为来评估延迟。
分析了共 891 名参与者的数据，他们的中位年龄为 36 岁，CD4 计数为 67 个细胞/mm³。患者、系统和总延迟的中位数分别为 28 天、1 天和 28 天。失业、在 Tshepong 医院接受治疗、饮酒、拥挤指数、寻求前期治疗、复方新诺明治疗和世界卫生组织（WHO）第 4 期疾病与总延迟延长相关。
在 HIV 高流行的情况下，患者寻求 TB 治疗的时间延迟是很大的。确定的与延迟相关的因素可用于开发干预措施，以改善 TB 的求医行为和早期诊断。
