Human Sciences Research Council, Cape Town, South Africa.
School of Public Health and Family, University of Cape Town, Cape Town, South Africa.
PLoS One. 2023 Mar 15;18(3):e0282125. doi: 10.1371/journal.pone.0282125. eCollection 2023.
Although tuberculosis (TB) symptoms have limited sensitivity they remain an important entry point into the TB care cascade.
To investigate self-reported healthcare seeking for TB symptoms in participants in a community-based survey.
We compared reasons for not seeking care in participants reporting ≥1 of four TB screening symptoms (cough, weight loss, night sweats, fever) in the first South African national TB prevalence survey (2017-2019). We used logistic regression analyses to identify sociodemographic and clinical characteristics associated with healthcare seeking.
5,168/35,191 (14.7%) survey participants reported TB symptoms and 3,442/5168 had not sought healthcare. 2,064/3,442(60.0%) participants intended to seek care, 912 (26.5%) regarded symptoms as benign, 399 (11.6%) reported access barriers(distance and cost), 36 (1.0%) took other medications and 20(0.6%) reported health system barriers. Of the 57/98 symptomatic participants diagnosed with bacteriologically confirmed TB who had not sought care: 38(66.7%) intended to do so, 8(14.0%) regarded symptoms as benign, and 6(10.5%) reported access barriers. Among these 98, those with unknown HIV status(OR 0.16 95% CI 0.03-0.82), p = 0.03 and those who smoked tobacco products(OR 0.39, 95% CI 0.17-0.89, p = 0.03) were significantly less likely to seek care.
People with TB symptoms delayed seeking healthcare, many regarded symptoms as benign while others faced access barriers. Those with unknown HIV status were significantly less likely to seek care. Strengthening community-based TB awareness and screening programmes together with self-screening models could increase awareness of the significance of TB symptoms and contribute to improving healthcare seeking and enable many people with TB to enter the TB care cascade.
尽管结核病（TB）症状的敏感性有限，但它们仍然是进入结核病护理级联的重要切入点。
调查社区为基础的调查中参与者对结核病症状的自我报告医疗服务寻求情况。
我们比较了在 2017-2019 年南非首次全国结核病患病率调查中报告≥4 种结核病筛查症状（咳嗽、体重减轻、盗汗、发热）之一的参与者未寻求护理的原因。我们使用逻辑回归分析来确定与医疗服务寻求相关的社会人口学和临床特征。
在 35191 名调查参与者中，有 5168 人（14.7%）报告了结核病症状，其中 3442 人（60.0%）未寻求医疗服务。3442 名参与者中，有 2064 人（60.0%）打算寻求医疗服务，912 人（26.5%）认为症状良性，399 人（11.6%）报告存在获取障碍（距离和费用），36 人（1.0%）服用其他药物，20 人（0.6%）报告存在卫生系统障碍。在 98 名有症状但未寻求医疗服务的菌检确诊结核病患者中，有 38 人（66.7%）打算寻求医疗服务，8 人（14.0%）认为症状良性，6 人（10.5%）报告存在获取障碍。在这些 98 人中，那些 HIV 状况未知的人（比值比 0.16，95%CI 0.03-0.82，p = 0.03）和那些吸烟的人（比值比 0.39，95%CI 0.17-0.89，p = 0.03）寻求医疗服务的可能性显著降低。
有结核病症状的人延迟寻求医疗服务，许多人认为症状良性，而其他人则面临获取障碍。那些 HIV 状况未知的人寻求医疗服务的可能性显著降低。加强社区为基础的结核病意识和筛查计划以及自我筛查模式可以提高对结核病症状重要性的认识，有助于改善医疗服务寻求，并使许多结核病患者能够进入结核病护理级联。
