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Prescribed and self-medication use increase delays in diagnosis of tuberculosis in the country of Georgia.

ABSTRACT: Georgia has a high burden of tuberculosis (TB), including multidrug-resistant TB. Enhancing early diagnosis of TB is a priority to reduce transmission.To quantify delays in TB diagnosis and identify risk factors for delay in the country of Georgia.In a cross-sectional study, persons with newly diagnosed, culture-confirmed pulmonary TB were interviewed within 2 months of diagnosis and medical and laboratory records were abstracted.Among 247 persons enrolled, the mean and median total TB diagnostic delay was respectively 89.9 and 59.5 days. The mean and median patient delay was 56.2 and 23.5 days, while health care system delay was 33.7 and 14.0 days. In multivariable analysis, receipt of a medication prior to TB diagnosis was associated with increased overall diagnostic delay (adjusted odds ratio [aOR] 2.28, 95%CI 1.09-4.79); antibiotic use prior to diagnosis increased the risk of prolonged health care delay (aOR 4.16, 95%CI 1.97-8.79). TB cases who had increased patient-related diagnostic delay were less likely to have prolonged health care diagnostic delay (aOR 0.38, 95%CI 0.19-0.74).Prolonged delays in detecting TB are common in Georgia. Interventions addressing the misuse of antibiotics and targeting groups at risk for prolonged delay are warranted to reduce diagnostic delays and enhance TB control.

SUBMITTER: Rabin AS

PROVIDER: S-EPMC3587776 | biostudies-literature | 2013 Feb

REPOSITORIES: biostudies-literature

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Prescribed and self-medication use increase delays in diagnosis of tuberculosis in the country of Georgia.

Rabin A S AS Kuchukhidze G G Sanikidze E E Kempker R R RR Blumberg H M HM

The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease 20121205 2

<h4>Setting</h4>Georgia has a high burden of tuberculosis (TB), including multidrug-resistant TB. Enhancing early diagnosis of TB is a priority to reduce transmission.<h4>Objective</h4>To quantify delays in TB diagnosis and identify risk factors for delay in the country of Georgia.<h4>Design</h4>In a cross-sectional study, persons with newly diagnosed, culture-confirmed pulmonary TB were interviewed within 2 months of diagnosis and medical and laboratory records were abstracted.<h4>Results</h4>A ...[more]

PMID: 23228464

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Project description:BackgroundThe global spread of the human immunodeficiency virus (HIV) is the main hypothesis behind tuberculosis (TB) positive trends in the last decades, according to modeling studies and World Health Organization Reports (WHO). On one hand, TB (WHO) reports do not explicitly consider a modeling approach, but cover country and global TB trends. On the other hand, modeling studies usually do not cover the scale of WHO reports, because of the amount of parameters estimated to describe TB natural history. Here we combined these two principal sources of TB studies covering TB High Burden Countries (HBCs) dynamics. Our main goals were: (i) to detect the endogenous component of TB dynamics since 1974 for TB HBCs; and (ii) to explore the HIV exogenous effects on TB models`parameters.Methods and findingsWe explored the relationship between the TB per capita population rate of change (RI) and the infectious class size following an endogenous/exogenous framework. RI can be affected by intra-population processes (i.e. competition, predation) and exogenous variables like HIV. We found that TB dynamics had always a strong endogenous component, represented by a negative correlation between TB population size and RI, which was captured by the discrete logistic model. Moreover, we explored the HIV exogenous effects on TB models`parameters. We found that overall the TB+HIV logistic model was more parsimonious than TB model alone, principally in the African region. Our results showed that HIV affected principally TB carrying capacity, as expected by the known HIV effects on TB natural-history. We also tested if DOTS (Directly Observed Treatment Short-Course Strategy), poverty levels and BCG (Bacillus Calmette-Guérin) coverage explained the models´ residuals variances, but they did not.ConclusionsSince 1974, TB dynamics were categorized in distinct chronological domains, with different dynamics but nearly the same underlying mechanism: a negative relationship between RI and infected class size (i.e. self-limiting). In the last decades, not only HIV spread represented a new TB chronological domain, but it also has been pushing TB carrying capacity (K) to higher levels. TB has a complex natural-history and imposes real challenges to model its dynamics. Yet, we were able to explore and reveal the main drivers of TB dynamics for HBCs since 1974, through a simple approach. Based on our results, we suggest that the endogenous view should be considered as a plausible hypothesis to model and explain TB dynamics and that future World Health Organization reports could include the endogenous/exogenous framework as a supplement to help to decipher the main drivers of TB dynamics and other diseases.

Project description:BackgroundBrucellosis is an endemic disease in the country of Georgia. According to the National Center for Disease Control and Public Health of Georgia (NCDC), the average annual number of brucellosis cases was 161 during 2008-2012. However, the true number of cases is thought to be higher due to underreporting. The aim of this study was to provide current epidemiological and clinical information and evaluate diagnostic methods used for brucellosis in Georgia.MethodologyAdult patients were eligible for participation if they met the suspected or probable case definition for brucellosis. After consent participants were interviewed using a standardized questionnaire to collect information on socio-demographic characteristics, epidemiology, history of present illness, and clinical manifestation. For the diagnosis of brucellosis, culture and serological tests were used.ResultsA total of 81 participants were enrolled, of which 70 (86%) were from rural areas. Seventy-four percent of participants reported consuming unpasteurized milk products and 62% consuming undercooked meat products before symptom onset. Forty-one participants were positive by the Wright test and 33 (41%) were positive by blood culture. There was perfect agreement between the Huddelston and Wright tests (k = 1.0). Compared with blood culture (the diagnostic gold standard), ELISA IgG and total ELISA (IgG + IgM), the Wright test had fair (k = 0.12), fair (k = 0.24), and moderate (k = 0.52) agreement, respectively.ConclusionsConsumption of unpasteurized milk products and undercooked meat were among the most common risk factors in brucellosis cases. We found poor agreement between ELISA tests and culture results. This report also serves as an initial indication that the suspected case definition for brucellosis surveillance purposes needs revision. Further research is needed to characterize the epidemiology and evaluate the performance of the diagnostic methods for brucellosis in Georgia.

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Prescribed and self-medication use increase delays in diagnosis of tuberculosis in the country of Georgia.

Publications

Prescribed and self-medication use increase delays in diagnosis of tuberculosis in the country of Georgia.

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