Socio-demographic Factors Associated with Treatment Initiation Delays among Tuberculosis Patients in Namibia
Francis F. Chikuse *
Pathcare, 155 Nelson Mandela, Eros, Windhoek, Namibia.
Loveness N. Dzikiti
School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
Auxilia Chideme-Munodawafa
Health Services Board, Harare, Zimbabwe.
Talkmore Maruta
ECSA Health Initiative, Arusha, Tanzania.
Greanious A. Mavondo
Faculty of Health Sciences, National University of Science and Technology, Bulawayo, Zimbabwe.
Munyaradzi Mukesi
Faculty of Health and Applied Sciences, Namibia University of Science and Technology, Windhoek, Namibia.
Mathew Maisiri
Frank-Mat Diagnostics, Box 9207 Eros, Windhoek, Namibia.
Patricia T. Gundidza
ZICHIRE Projects, Zimbabwe and School of Nursing, University of Namibia, Windhoek, Namibia.
Munyaradzi M. Soko
Pathcare, 155 Nelson Mandela, Eros, Windhoek, Namibia.
*Author to whom correspondence should be addressed.
Abstract
Background: Delayed tuberculosis (TB) treatment increases the rate of spread of the bacilli in the community and mortality rates. Rapid diagnosis and early TB treatment initiation are crucial to successful outcomes and delays affect TB control programs. In Namibia, there is a paucity of data on the demographic factors affecting TB treatment initiation since GeneXpert MTB/RIF (Xpert) assay was introduced in 2017.
Methods: This was a descriptive cross-sectional retrospective study conducted at Katutura Hospital TB clinic from 1st July 2018 to 31st March 2019. A total of seventy-two (72) participants comprising twenty-five (25) rifampicin resistant-TB (RR-TB) and forty-seven (47) non- RR-TB adult patients were enrolled using consecutive sampling. Patients’ medical records, Xpert results and a questionnaire were used to collect data. The data were analyzed using Stata statistical software version 12. Association between socio-demographic factors and treatment initiation delays were established using logistic regression analysis.
Results: Staying with a TB patient (AOR=17.22, 95% CI: 2.29-129.773), employment status (AOR=1.23, 95% CI, 002-129), previous TB treatment (AOR=2.19, 95% CI: 0.076-0.86) and being HIV positive (AOR= 1.23, 95% CI: 0.0034-057) were the socio-demographic factors that were significantly associated with treatment initiation delays. Treatment initiation delay median time at Katutura Intermediate Hospital TB Clinic was 10 days (IQR: 1-32) and 3 days (IQR: 0-12) for RR-TB and non- RR-TB respectively.
Conclusion: The prolonged treatment initiation delays among HIV positive RR-TB patients might be due to low adherence to HIV care interventions. Staying with a household TB patient and those who were previously treated for TB were also associated with treatment initiation delays. Poor health systems infrastructure and stigma could be the determinants of this delay in these groups. An integrated family-based approach to TB and HIV care involving health care workers can mitigate TB treatment delays post-diagnosis. Further studies should explore the factors associated with late initiation to second-line treatment from a community perspective. Lastly, there is a need to assess the cost-utility of bedaquiline and delamanid drugs roll-out in Namibian health care in comparison with the standard treatment.
Keywords: Socio-demographic, Rifampicin resistant TB, treatment initiation, Genexpert MTB/RIF assay, cross-sectional study.