Incidence and Comparison of the Factors associated with Treatment Delay of Tuberculosis in the UK and India - A Systematic Review

Abstract

Background:  Tuberculosis (TB) remains a significant public health issue globally.  A significant number of TB patients have been seen to have over 4 months delay in their diagnosis and treatment. Late initiation of treatment of TB increases the risk of its severity and transmission of the disease further in communities.  A delay, both pulmonary and extra-pulmonary, is a major set-back in TB control worldwide.  Reducing delay to access care is important to reduce the TB burden in countries like India with a high incidence of TB. The review aims to observe the treatment delay in India and the UK, identify and compare the associated risk factors and also, assess their effect on the treatment outcomes. It is also important to classify the delays, risk factors associated with them and their effect on the treatment outcome.

Methods:  CINHAL, Medline, and Google Scholar were searched for studies that assessed factors associated with delays in diagnosis and treatment in populations suffering from TB in India and UK. Studies done between 2017-2021, satisfying the exclusion criteria were selected, followed by data extraction and analysis of the evidence through a narrative synthesis. Quality appraisal was an important step in the systematic review to maintain internal validity.

Results: The findings suggest the existence of treatment initiation delays in both the UK and India. Both countries have individual factors as well as common reasons for the delays. The factors include socio-demographic characteristics, TB-related symptoms, and conditions of seeking medical care. The median delay in initial care seeking and diagnosis was calculated as 10 days each, and 2 days for treatment initiation. The various domains identified for delay were negligence, facility-related issues, and social reasons. Such factors led to health-seeking delays and further delay in treatment initiation.

Conclusions: Future studies must use stronger evidence through cohort and case-control studies to establish further clarity on the factors associated with the delays. Interventions for reducing the  knowledge  gap  and  stigma,  increasing  the  accessibility  of  services,  active  case  finding; capacity building of providers, quality assured sputum microscopy, and communication skills will help reduce these delays.