TB treatment delays and associated risk factors in Dushanbe, Tajikistan, 2019–2021

Sharifov R. Nabirova D. Tilloeva Z. Zikriyarova S. Kishore N. Jafarov N. Yusufi S. Horth R.
December 2024 BioMed Central Ltd

BMC Infectious Diseases
2024 #24 Issue 1

Background: 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. Methods: 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). Results: 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]). Conclusions: 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.

COVID-19 , Health care system delay , Patient delay , Tajikistan , Tuberculosis

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Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
Municipal Disinfection Station, Dushanbe, Tajikistan
Central Asia Advanced Field Epidemiology Training Program, Almaty, Kazakhstan
Central Asia Office, U.S. Centers for Disease Control and Prevention, Almaty, Kazakhstan
Global Immunizations Division, U.S. Centers for Disease Control and Prevention, Atlanta, United States
Ministry of Health and Social Protection of the Republic of Tajikistan, Dushanbe, Tajikistan
Avicenna Tajik State Medical University, Dushanbe, Tajikistan

Asfendiyarov Kazakh National Medical University
Municipal Disinfection Station
Central Asia Advanced Field Epidemiology Training Program
Central Asia Office
Global Immunizations Division
Ministry of Health and Social Protection of the Republic of Tajikistan
Avicenna Tajik State Medical University

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