Most studies of delayed tuberculosis diagnosis focus on how the delay affects patient outcomes and community transmission.
A UGA study takes a new angle on the issue, looking at the potential societal influence on the delays and how to prevent them.
TB is an infectious bacterial disease that often attacks the lungs and affects 8 million people worldwide; it kills 2 million annually. A delayed diagnosis is the largest public health hazard related to TB, as every step taken before treatment is an opportunity to transmit the disease to someone else, according to Dr. Juliet Sekandi, who previously practiced medicine and specializes in infectious diseases. She is now a postdoctoral research and teaching associate in the UGA College of Public Health.
Sekandi’s impetus for this specific research used the degrees of separation theory to study why practitioners see TB patients cycle through repeated diagnoses, defining each “degree” as a “step.” The study found that TB patients surveyed in Kampala, Uganda, circled through four separate steps while seeking care before reaching proper diagnosis and treatment. The study also found that strong community networks are vital to speeding up the process.
“I had to move away from the clinic and into the community that the TB patients came from to ask why they are coming back even after they’ve been given effective TB treatment,” said Sekandi, who is under the mentorship of Dr. Christopher Whalen, the Ernest Corn Professor of Infectious Disease Epidemiology in the college’s epidemiology and biostatistics department.
The study, published in the journal BioMed Central Infectious Diseases, used steps as the time variable as it calculated how long patients spent navigating throughout their social networks, community and health care providers.
The researchers then split the steps into two categories: health professionals who specialize in TB care and those who don’t. The latter group was found to represent a larger hurdle in a person’s timely diagnosis.
The ideal number of steps is one, from a patient directly to a TB-care provider. However, the extensive and disparate network of the Ugandan health care landscape often results in patients cycling in and out of the health care system, seeing many providers who are not specialized in TB diagnosis or treatment, Sekandi said.
Patients spent 41 percent of the total time between noticing symptoms and diagnosis in the first step. Social networks represented the majority of the second step and ultimately led to a quicker diagnosis than steps to non-TB providers, which exemplifies the importance of community and social network support in minimizing time to diagnosis, she said.
Second to delay in deciding to seek care, the time spent navigating through non-TB providers represented substantial hurdles to a timely diagnosis and comprised 34 percent of total time spent seeking care, according to the study.