Van Ness Sarah E, Chandra Ankit, Sarkar Sonali, Pleskunas Jane, Ellner Jerrold J, Roy Gautam, Lakshminarayanan Subitha, Sahu Swaroop, Horsburgh C Robert, Jenkins Helen E, Hochberg Natasha S
Department of Biostatistics, Boston University, Crosstown Building, 801 Massachusetts Avenue, 3rd Floor, Boston, MA, 02118, USA.
Department of Preventive and Social Medicine, JIPMER, Puducherry, India.
BMC Infect Dis. 2017 Aug 15;17(1):567. doi: 10.1186/s12879-017-2629-9.
Reducing delay to accessing care is necessary to reduce the Tuberculosis (TB) burden in high incidence countries such as India. This study aimed to identify factors associated with delays in seeking care for TB in Southern India.
We analyzed data from newly diagnosed, smear-positive, culture-confirmed, pulmonary TB patients in the Regional Prospective Observational Research for TB (RePORT) cohort in Puducherry and Tamil Nadu, India. Data were collected on demographic characteristics, symptom duration, and TB knowledge, among other factors. Delay was defined as cough ≥4 weeks before treatment initiation. Risky alcohol use was defined by the AUDIT-C score which incorporates information about regular alcohol use and binge drinking. TB knowledge was assessed by knowing transmission mode or potential curability.
Of 501 TB patients, 369 (73.7%) subjects delayed seeking care. In multivariable analysis, risky alcohol use was significantly associated with delay (aOR 2.20, 95% CI: 1.31, 3.68). Delay was less likely in lower versus higher income groups (<3000 versus >10,000 rupees/month, aOR 0.31, 95% CI: 0.12, 0.78). TB knowledge was not significantly associated with delay.
Local TB programs should consider that risky alcohol users may delay seeking care for TB. Further studies will be needed to determine why patients with higher income delay in seeking care.
在印度等高发病率国家，减少获得治疗的延迟对于减轻结核病负担至关重要。本研究旨在确定印度南部结核病患者寻求治疗延迟的相关因素。
我们分析了印度本地治里和泰米尔纳德邦结核病区域前瞻性观察研究（RePORT）队列中新诊断的、涂片阳性、培养确诊的肺结核患者的数据。收集了人口统计学特征、症状持续时间和结核病知识等因素的数据。延迟定义为治疗开始前咳嗽≥4周。危险饮酒通过包含定期饮酒和暴饮信息的酒精使用障碍识别测试（AUDIT-C）评分来定义。结核病知识通过了解传播方式或潜在可治愈性来评估。
在501名结核病患者中，369名（73.7%）患者延迟寻求治疗。在多变量分析中，危险饮酒与延迟显著相关（调整后比值比[aOR]为2.20，95%置信区间[CI]：1.31，3.68）。低收入组与高收入组相比延迟的可能性较小（<3000卢比/月与>10,000卢比/月，aOR为0.31，95%CI：0.12，0.78）。结核病知识与延迟无显著关联。
当地结核病项目应考虑到危险饮酒者可能延迟寻求结核病治疗。需要进一步研究以确定高收入患者延迟寻求治疗的原因。
