Sharifov Radzhabali, Nabirova Dilyara, Tilloeva Zulfiya, Zikriyarova Sanam, Kishore Nishant, Jafarov Navruz, Yusufi Salomuddin, Horth Roberta
Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
Municipal Disinfection Station, Dushanbe, Tajikistan.
BMC Infect Dis. 2024 Dec 18;24(1):1398. doi: 10.1186/s12879-024-10265-8.
In Tajikistan, where there are about 8,000 cases annually, many new cases are being diagnosed with severe disease, indicating a delay in receiving care. We aimed to estimate the proportion with delayed care and the main factors contributing to delayed care.
Using a retrospective cohort design, we conducted a study that included all people aged over 15 years who were newly diagnosed with pulmonary TB in Dushanbe from 2019 to 2021. We defined 'patient delay' as > 14 days from TB symptom onset to the first provider visit and 'provider delay' as > 3 days from the first visit to treatment initiation. Data was abstracted from medical records and participants were interviewed in-person. Multivariable negative binomial regression was used to estimate adjusted risk ratios (aRR) and 95% confidence intervals (CI).
Of 472 participants, 49% were male, 65% had lung tissue cavitation, 33% had drug resistant TB, 11% had diabetes, 4% had HIV, and. Reported cases dropped from 196 in 2019 to 109 in 2020 and increased to 167 in 2021. The proportion of people experiencing patient delays was 82%, 72%, and 90% per year, respectively. The proportion of provider delays was 44%, 41% and 29% per year. Patient delay was associated with year (aRR: 1.09 [CI:1.02-1.18] in 2021 vs. 2019), age (aRR:0.91 [0.82-0.99] for 40-59-year-olds vs. 15-39-year-olds), having HIV (aRR:1.22 [1.08-1.38]), having blood in sputum (aRR:1.19 [1.10-1.28]), chest pain (aRR:1.32 [1.14-1.54]), having at least two structural barriers vs. none (aRR:1.52 [1.28-1.80]), having one of the following barriers: long wait lines (aRR:1.36 [1.03-1.80]), feeling that healthcare services were expensive (aRR:1.54 [1.28-1.85]), or having no time or too much work (aRR:1.54 [1.29-1.84]). Provider delay was associated with year (aRR: 0.67 [0.51-0.89] in 2021 vs. 2019), patients having to pay for X-ray services (aRR: 1.59 [1.22-2.07]) and lacking direct-observed-therapy (DOTS) in facility (aRR: 1.61 [1.03-2.52]).
Patient delay was high before the COVID-19 pandemic and increased in 2021, while provider delay decreased during this time. Addressing structural barriers to healthcare services, such as increased DOTS facilities, expanded hours, and zero fees, may decrease delays.
在塔吉克斯坦，每年约有8000例病例，许多新诊断的病例病情严重，这表明在接受治疗方面存在延误。我们旨在估计延误治疗的比例以及导致延误治疗的主要因素。
采用回顾性队列设计，我们开展了一项研究，纳入了2019年至2021年在杜尚别新诊断为肺结核的所有15岁以上人群。我们将“患者延误”定义为从结核病症状出现到首次就诊超过14天，将“医疗服务提供者延误”定义为从首次就诊到开始治疗超过3天。数据从医疗记录中提取，并对参与者进行了面对面访谈。使用多变量负二项回归来估计调整后的风险比（aRR）和95%置信区间（CI）。
在472名参与者中，49%为男性，65%有肺组织空洞，33%有耐药结核病，11%有糖尿病，4%有艾滋病毒。报告的病例从2019年的196例降至2020年的109例，并在2021年增至167例。每年经历患者延误的比例分别为82%、72%和90%。医疗服务提供者延误的比例分别为44%、41%和29%。患者延误与年份相关（2021年与2019年相比，aRR：1.09 [CI：1.02 - 1.18]）、年龄相关（40 - 59岁与15 - 39岁相比，aRR：0.91 [0.82 - 0.99]）、感染艾滋病毒相关（aRR：1.22 [1.08 - 1.38]）、痰中带血相关（aRR：1.19 [1.10 - 1.28]）、胸痛相关（aRR：1.32 [1.14 - 1.54]）、有至少两个结构障碍与无结构障碍相比（aRR：1.52 [1.28 - 1.80]）、有以下障碍之一：排队时间长（aRR：1.36 [1.03 - 1.80]）、感觉医疗服务昂贵（aRR：1.54 [1.28 - 1.85]）或没有时间或工作太多（aRR：1.54 [1.29 - 1.84]）。医疗服务提供者延误与年份相关（2021年与2019年相比，aRR：0.67 [0.51 - 0.89]）、患者需支付X光服务费用相关（aRR：1.59 [1.22 - 2.07]）以及医疗机构缺乏直接观察治疗（DOTS）相关（aRR：1.61 [1.03 - 2.52]）。
在新冠疫情之前患者延误率就很高，2021年有所增加，而在此期间医疗服务提供者延误有所减少。解决医疗服务的结构障碍，如增加DOTS设施、延长服务时间和零费用，可能会减少延误。
