Background: Delaying tuberculosis (TB) treatment increases the rate of bacilli spread in the population, as well as mortality rates. Rapid diagnosis and initiation of TB care are critical for good outcomes, and delays have a negative impact on TB management programmes. Since the introduction of the GeneXpert MTB/RIF (Xpert) assay in 2017, there has been a scarcity of data on the demographic factors influencing TB treatment initiation in Namibia.
Methods: From July 1, 2018 to March 31, 2019, a descriptive cross-sectional retrospective analysis was performed at Katutura Hospital’s TB clinic. Using consecutive sampling, seventy-two (72) adult patients were enrolled, with twenty-five (25) rifampicin resistant-TB (RR-TB) and forty-seven (47) non-RR-TB patients. Data was gathered from patients’ medical records, Xpert results, and a questionnaire. Stata statistical software version 12 was used to analyse the results. Logistic regression analysis was used to find a connection between socio-demographic variables and treatment initiation delays.
The socio-demographic factors that were substantially correlated with treatment initiation delays were staying with a TB patient (AOR=17.22, 95 percent CI: 2.29-129.773), job status (AOR=1.23, 95 percent CI: 002-129), prior TB treatment (AOR=2.19, 95 percent CI: 0.076-0.86), and being HIV positive (AOR= 1.23, 95 percent CI: 0.0034-057). Treatment initiation delay was 10 days (IQR: 1-32) for RR-TB and 3 days (IQR: 0-12) for non-RR-TB at Katutura Intermediate Hospital TB Clinic, respectively.
Conclusion: Poor adherence to HIV care interventions may be to blame for the prolonged treatment initiation delays among HIV positive RR-TB patients. Treatment initiation delays were also linked to living with a household TB patient and those who had previously been treated for TB. Delays in these communities may be caused by a lack of health-care facilities and stigma. Post-diagnosis TB treatment delays can be reduced by using an integrated family-based approach to TB and HIV care that includes health care staff. From a community perspective, further research into the factors associated with late initiation of second-line care is needed. Finally, in contrast to standard treatment, it is essential to determine the cost-utility of bedaquiline and delamanid drug implementation in Namibian health care. An integrated, family-centered approach to TB and HIV care involving health workers, based on the SEM model, needs to be piloted to see whether it can minimise treatment initiation. This strategy has the potential to significantly improve the management of tuberculosis in women, infants, and other vulnerable groups.
Author (s) Details
Francis F. Chikuse
US-CDC:Ministry of Health and Social Services Windhoek, Namibia and Faculty of Health and Applied Sciences, Namibia University of Science and Technology, Windhoek, Namibia.
Loveness N. Dzikiti
School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
Health Services Board, Harare, Zimbabwe.
Africa-CDC, Addis Ababa, Ethiopia.
Greanious A. Mavondo
Faculty of Health Sciences, National University of Science and Technology, Bulawayo, Zimbabwe.
Faculty of Health and Applied Sciences, Namibia University of Science and Technology, Windhoek, Namibia.
Frank-Mat Diagnostics, Box 9207 Eros, Windhoek, Namibia.
Patricia T. Gundidza
ZICHIRE Projects, Zimbabwe
Munyaradzi M. Soko
Pathcare Windhoek, Namibia.
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