Health care seeking patterns of rifampicin-resistant tuberculosis patients in Harare, Zimbabwe: A prospective cohort study.

<h4>Background</h4>Delays in seeking and accessing treatment for rifampicin-resistant tuberculosis (RR-TB) and multi-drug resistant (MDR-TB) are major impediments to TB control in high-burden, resource-limited settings.<h4>Method</h4>We prospectively determined health-seeking...

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Autores principales:	Rebecca Tadokera, Stella Huo, Grant Theron, Collins Timire, Salome Manyau-Makumbirofa, John Z Metcalfe
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/c05c020320f34ccb8c40214e638a31fb
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spelling	oai:doaj.org-article:c05c020320f34ccb8c40214e638a31fb2021-12-02T20:06:54ZHealth care seeking patterns of rifampicin-resistant tuberculosis patients in Harare, Zimbabwe: A prospective cohort study.1932-620310.1371/journal.pone.0254204https://doaj.org/article/c05c020320f34ccb8c40214e638a31fb2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254204https://doaj.org/toc/1932-6203<h4>Background</h4>Delays in seeking and accessing treatment for rifampicin-resistant tuberculosis (RR-TB) and multi-drug resistant (MDR-TB) are major impediments to TB control in high-burden, resource-limited settings.<h4>Method</h4>We prospectively determined health-seeking behavioural patterns and associations with treatment outcomes and costs among 68 RR-TB patients attending conveniently selected facilities in a decentralised system in Harare, Zimbabwe.<h4>Results</h4>From initial symptoms to initiation of effective treatment, patients made a median number of three health care visits (IQR 2-4 visits) at a median cost of 13% (IQR 6-31%) of their total annual household income (mean cost, US$410). Cumulatively, RR-TB patients most frequently first visited private facilities, i.e., private pharmacies (30%) and other private health care providers (24%) combined. Median patient delay was 26 days (IQR 14-42 days); median health system delay was 97 days (IQR 30-215 days) and median total delay from symptom onset to initiation of effective treatment was 132 days (IQR 51-287 days). The majority of patients (88%) attributed initial delay in seeking care to "not feeling sick enough." Total delay, total cost and number of health care visits were not associated with treatment or clinical outcomes, though our study was not adequately powered for these determinations.<h4>Conclusions</h4>Despite the public availability of rapid molecular TB tests, patients experienced significant delays and high costs in accessing RR-TB treatment. Active case finding, integration of private health care providers and enhanced service delivery may reduce treatment delay and TB associated costs.Rebecca TadokeraStella HuoGrant TheronCollins TimireSalome Manyau-MakumbirofaJohn Z MetcalfePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0254204 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Rebecca Tadokera Stella Huo Grant Theron Collins Timire Salome Manyau-Makumbirofa John Z Metcalfe Health care seeking patterns of rifampicin-resistant tuberculosis patients in Harare, Zimbabwe: A prospective cohort study.
description	<h4>Background</h4>Delays in seeking and accessing treatment for rifampicin-resistant tuberculosis (RR-TB) and multi-drug resistant (MDR-TB) are major impediments to TB control in high-burden, resource-limited settings.<h4>Method</h4>We prospectively determined health-seeking behavioural patterns and associations with treatment outcomes and costs among 68 RR-TB patients attending conveniently selected facilities in a decentralised system in Harare, Zimbabwe.<h4>Results</h4>From initial symptoms to initiation of effective treatment, patients made a median number of three health care visits (IQR 2-4 visits) at a median cost of 13% (IQR 6-31%) of their total annual household income (mean cost, US$410). Cumulatively, RR-TB patients most frequently first visited private facilities, i.e., private pharmacies (30%) and other private health care providers (24%) combined. Median patient delay was 26 days (IQR 14-42 days); median health system delay was 97 days (IQR 30-215 days) and median total delay from symptom onset to initiation of effective treatment was 132 days (IQR 51-287 days). The majority of patients (88%) attributed initial delay in seeking care to "not feeling sick enough." Total delay, total cost and number of health care visits were not associated with treatment or clinical outcomes, though our study was not adequately powered for these determinations.<h4>Conclusions</h4>Despite the public availability of rapid molecular TB tests, patients experienced significant delays and high costs in accessing RR-TB treatment. Active case finding, integration of private health care providers and enhanced service delivery may reduce treatment delay and TB associated costs.
format	article
author	Rebecca Tadokera Stella Huo Grant Theron Collins Timire Salome Manyau-Makumbirofa John Z Metcalfe
author_facet	Rebecca Tadokera Stella Huo Grant Theron Collins Timire Salome Manyau-Makumbirofa John Z Metcalfe
author_sort	Rebecca Tadokera
title	Health care seeking patterns of rifampicin-resistant tuberculosis patients in Harare, Zimbabwe: A prospective cohort study.
title_short	Health care seeking patterns of rifampicin-resistant tuberculosis patients in Harare, Zimbabwe: A prospective cohort study.
title_full	Health care seeking patterns of rifampicin-resistant tuberculosis patients in Harare, Zimbabwe: A prospective cohort study.
title_fullStr	Health care seeking patterns of rifampicin-resistant tuberculosis patients in Harare, Zimbabwe: A prospective cohort study.
title_full_unstemmed	Health care seeking patterns of rifampicin-resistant tuberculosis patients in Harare, Zimbabwe: A prospective cohort study.
title_sort	health care seeking patterns of rifampicin-resistant tuberculosis patients in harare, zimbabwe: a prospective cohort study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/c05c020320f34ccb8c40214e638a31fb
work_keys_str_mv	AT rebeccatadokera healthcareseekingpatternsofrifampicinresistanttuberculosispatientsinhararezimbabweaprospectivecohortstudy AT stellahuo healthcareseekingpatternsofrifampicinresistanttuberculosispatientsinhararezimbabweaprospectivecohortstudy AT granttheron healthcareseekingpatternsofrifampicinresistanttuberculosispatientsinhararezimbabweaprospectivecohortstudy AT collinstimire healthcareseekingpatternsofrifampicinresistanttuberculosispatientsinhararezimbabweaprospectivecohortstudy AT salomemanyaumakumbirofa healthcareseekingpatternsofrifampicinresistanttuberculosispatientsinhararezimbabweaprospectivecohortstudy AT johnzmetcalfe healthcareseekingpatternsofrifampicinresistanttuberculosispatientsinhararezimbabweaprospectivecohortstudy
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Health care seeking patterns of rifampicin-resistant tuberculosis patients in Harare, Zimbabwe: A prospective cohort study.

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