Journal
INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE
Volume 22, Issue 3, Pages 280-+Publisher
INT UNION AGAINST TUBERCULOSIS LUNG DISEASE (I U A T L D)
DOI: 10.5588/ijtld.17.0539
Keywords
TB; human immunodeficiency virus; health seeking; symptom screening
Categories
Funding
- National Institutes for Health (NIH), Bethesda, MD, USA [1R01 AI093316]
- National Institute of Allergy and Infectious Diseases, Bethesda [R01 AI093316]
- Johns Hopkins Center for AIDS Research, Baltimore, MD, USA [P30 AI094189]
- [WT 200901/21161Z]
- Medical Research Council [MR/K012126/1] Funding Source: researchfish
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SETTING: Ten primary health clinics in rural Thyolo District, Malawi. OBJECTIVE : Tuberculosis (TB) is a common initial presentation of human immunodeficiency virus (HIV) infection. We investigated the time from TB symptom onset to HIV diagnosis to describe TB health-seeking behaviour in adults newly diagnosed with HIV. DESIGN: We asked adults (>= 18 years) about the presence and duration of TB symptoms at the time of receiving a new HIV diagnosis. Associations with delayed health seeking (defined as >30 and >90 days from the onset of TB symptoms) were evaluated using multivariable logistic regression. RESULTS : TB symptoms were reported by 416 of 1265 participants (33%), of whom 36% (150/416) had been symptomatic for >30 days before HIV testing. Most participants (260/416, 63%) were below the poverty line (US$0.41 per household member per day). Patients who first sought care from informal providers had an increased odds of delay of >30 days (adjusted odds ratio [aOR] 1.6, 95% CI 0.9-2.8) or 90 days (aOR 2.0, 95% CI 1.1-3.8). CONCLUSIONS : Delayed health seeking for TB-related symptoms was common. Poverty was ubiquitous, but had no clear relationship to diagnostic delay. HIV-positive individuals who first sought care from informal providers were more likely to experience diagnostic delays for TB symptoms.
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