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Delay in seeking care for tuberculosis symptoms among adults newly diagnosed with HIV in rural Malawi

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Ngwira, Lucky-Gift, Dowdy, D. W., Khundi, M., Barnes, G. L., Nkhoma, A., Choko, A. T., Murowa, M., Chaisson, R. E., Corbett, E. L. and Fielding, K. (2018) 'Delay in seeking care for tuberculosis symptoms among adults newly diagnosed with HIV in rural Malawi'. The International Journal of Tuberculosis and Lung Disease, Vol 22, Issue 3, pp. 280-286.

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Abstract

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.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis
WF Respiratory System > Tuberculosis > WF 360 Drug therapy
WF Respiratory System > Lungs > WF 600 Lungs
Digital Object Identifer (DOI): https://doi.org/10.5588/ijtld.17.0539
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 08 Mar 2018 16:35
Last Modified: 01 Sep 2018 01:02
URI: http://archive.lstmed.ac.uk/id/eprint/8296

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