Pathways to care and preferences for improving tuberculosis services among tuberculosis patients in Zambia: A discrete choice experiment.

<h4>Background</h4>Delays in the diagnosis of tuberculosis (TB) contribute to a substantial proportion of TB-related mortality, especially among people living with HIV (PLHIV). We sought to characterize the diagnostic journey for HIV-positive and HIV-negative patients with a new TB diagn...

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Autores principales:	Andrew D Kerkhoff, Mary Kagujje, Sarah Nyangu, Kondwelani Mateyo, Nsala Sanjase, Lophina Chilukutu, Ingrid Eshun-Wilson, Elvin H Geng, Diane V Havlir, Monde Muyoyeta
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f2ce2b257ce64d12a8b4b2426a67f4cf
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spelling	oai:doaj.org-article:f2ce2b257ce64d12a8b4b2426a67f4cf2021-12-02T20:17:29ZPathways to care and preferences for improving tuberculosis services among tuberculosis patients in Zambia: A discrete choice experiment.1932-620310.1371/journal.pone.0252095https://doaj.org/article/f2ce2b257ce64d12a8b4b2426a67f4cf2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252095https://doaj.org/toc/1932-6203<h4>Background</h4>Delays in the diagnosis of tuberculosis (TB) contribute to a substantial proportion of TB-related mortality, especially among people living with HIV (PLHIV). We sought to characterize the diagnostic journey for HIV-positive and HIV-negative patients with a new TB diagnosis in Zambia, to understand drivers of delay, and characterize their preferences for service characteristics to inform improvements in TB services.<h4>Methods</h4>We assessed consecutive adults with newly microbiologically-confirmed TB at two public health treatment facilities in Lusaka, Zambia. We administered a survey to document critical intervals in the TB care pathway (time to initial care-seeking, diagnosis and treatment initiation), identify bottlenecks and their reasons. We quantified patient preferences for a range of characteristics of health services using a discrete choice experiment (DCE) that assessed 7 attributes (distance, wait times, hours of operation, confidentiality, sex of provider, testing incentive, TB test speed and notification method).<h4>Results</h4>Among 401 patients enrolled (median age of 34 years, 68.7% male, 46.6% HIV-positive), 60.9% and 39.1% were from a first-level and tertiary hospital, respectively. The median time from symptom onset to receipt of TB treatment was 5.0 weeks (IQR: 3.6-8.0) and was longer among HIV-positive patients seeking care at a tertiary hospital than HIV-negative patients (6.4 vs. 4.9 weeks, p = 0.002). The time from symptom onset to initial presentation for evaluation accounted for the majority of time until treatment initiation (median 3.0 weeks, IQR: 1.0-5.0)-an important minority of 11.0% of patients delayed care-seeking ≥8 weeks. The DCE found that patients strongly preferred same-day TB test results (relative importance, 37.2%), facilities close to home (18.0%), and facilities with short wait times (16.9%). Patients were willing to travel to a facility up to 7.6 kilometers further away in order to access same-day TB test results. Preferences for improving current TB services did not differ according to HIV status.<h4>Conclusions</h4>Prolonged intervals from TB symptom onset to treatment initiation were common, especially among PLHIV, and were driven by delayed health-seeking. Addressing known barriers to timely diagnosis and incorporating patients' preferences into TB services, including same-day TB test results, may facilitate earlier TB care engagement in high burden settings.Andrew D KerkhoffMary KagujjeSarah NyanguKondwelani MateyoNsala SanjaseLophina ChilukutuIngrid Eshun-WilsonElvin H GengDiane V HavlirMonde MuyoyetaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0252095 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Andrew D Kerkhoff Mary Kagujje Sarah Nyangu Kondwelani Mateyo Nsala Sanjase Lophina Chilukutu Ingrid Eshun-Wilson Elvin H Geng Diane V Havlir Monde Muyoyeta Pathways to care and preferences for improving tuberculosis services among tuberculosis patients in Zambia: A discrete choice experiment.
description	<h4>Background</h4>Delays in the diagnosis of tuberculosis (TB) contribute to a substantial proportion of TB-related mortality, especially among people living with HIV (PLHIV). We sought to characterize the diagnostic journey for HIV-positive and HIV-negative patients with a new TB diagnosis in Zambia, to understand drivers of delay, and characterize their preferences for service characteristics to inform improvements in TB services.<h4>Methods</h4>We assessed consecutive adults with newly microbiologically-confirmed TB at two public health treatment facilities in Lusaka, Zambia. We administered a survey to document critical intervals in the TB care pathway (time to initial care-seeking, diagnosis and treatment initiation), identify bottlenecks and their reasons. We quantified patient preferences for a range of characteristics of health services using a discrete choice experiment (DCE) that assessed 7 attributes (distance, wait times, hours of operation, confidentiality, sex of provider, testing incentive, TB test speed and notification method).<h4>Results</h4>Among 401 patients enrolled (median age of 34 years, 68.7% male, 46.6% HIV-positive), 60.9% and 39.1% were from a first-level and tertiary hospital, respectively. The median time from symptom onset to receipt of TB treatment was 5.0 weeks (IQR: 3.6-8.0) and was longer among HIV-positive patients seeking care at a tertiary hospital than HIV-negative patients (6.4 vs. 4.9 weeks, p = 0.002). The time from symptom onset to initial presentation for evaluation accounted for the majority of time until treatment initiation (median 3.0 weeks, IQR: 1.0-5.0)-an important minority of 11.0% of patients delayed care-seeking ≥8 weeks. The DCE found that patients strongly preferred same-day TB test results (relative importance, 37.2%), facilities close to home (18.0%), and facilities with short wait times (16.9%). Patients were willing to travel to a facility up to 7.6 kilometers further away in order to access same-day TB test results. Preferences for improving current TB services did not differ according to HIV status.<h4>Conclusions</h4>Prolonged intervals from TB symptom onset to treatment initiation were common, especially among PLHIV, and were driven by delayed health-seeking. Addressing known barriers to timely diagnosis and incorporating patients' preferences into TB services, including same-day TB test results, may facilitate earlier TB care engagement in high burden settings.
format	article
author	Andrew D Kerkhoff Mary Kagujje Sarah Nyangu Kondwelani Mateyo Nsala Sanjase Lophina Chilukutu Ingrid Eshun-Wilson Elvin H Geng Diane V Havlir Monde Muyoyeta
author_facet	Andrew D Kerkhoff Mary Kagujje Sarah Nyangu Kondwelani Mateyo Nsala Sanjase Lophina Chilukutu Ingrid Eshun-Wilson Elvin H Geng Diane V Havlir Monde Muyoyeta
author_sort	Andrew D Kerkhoff
title	Pathways to care and preferences for improving tuberculosis services among tuberculosis patients in Zambia: A discrete choice experiment.
title_short	Pathways to care and preferences for improving tuberculosis services among tuberculosis patients in Zambia: A discrete choice experiment.
title_full	Pathways to care and preferences for improving tuberculosis services among tuberculosis patients in Zambia: A discrete choice experiment.
title_fullStr	Pathways to care and preferences for improving tuberculosis services among tuberculosis patients in Zambia: A discrete choice experiment.
title_full_unstemmed	Pathways to care and preferences for improving tuberculosis services among tuberculosis patients in Zambia: A discrete choice experiment.
title_sort	pathways to care and preferences for improving tuberculosis services among tuberculosis patients in zambia: a discrete choice experiment.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/f2ce2b257ce64d12a8b4b2426a67f4cf
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Pathways to care and preferences for improving tuberculosis services among tuberculosis patients in Zambia: A discrete choice experiment.

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