ArticleERJ open research2020
Factors associated with delay in treatment initiation for pulmonary tuberculosis.
Article in ERJ open research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 36 citations in OpenAlex.
- Tuberculosis in adult migrants in Europe: a TBnet consensus statement.The European respiratory journal · 2025Pooled it
- Rural Residence and One-Person Households Are Associated with Diagnostic Delay in Pulmonary Tuberculosis in a Low-Incidence European Setting.Tropical medicine and infectious disease · 2026Article
- Exposures associated with tuberculosis presentation and healthcare delays in South West England, 2015-2020.PloS one · 2026Article
- A rapid review of the causes of diagnostic and treatment delays for tuberculosis in low-burden countries.Journal of public health (Oxford, England) · 2025Review
- Factors associated with patient and health care system delay among migrant and local tuberculosis patients in Istanbul: a cross-sectional study.BMC health services research · 2025Article
- Exploring Barriers to Timely Diagnosis and Treatment of Tuberculosis in Selangor, Malaysia: A Qualitative Study.The American journal of tropical medicine and hygiene · 2024Article
- Impact of integrating traditional care with the modern healthcare system in reducing tuberculosis diagnosis delays in Ethiopia: a clustered randomized controlled study.Tropical medicine and health · 2024Article
- Timely Pulmonary Tuberculosis Diagnosis Based on the Epidemiological Disease Spectrum: Population-Based Prospective Cohort Study in the Republic of Korea.JMIR public health and surveillance · 2024Article
- Article
- Time delays and risk factors in the management of patients with active pulmonary tuberculosis: nationwide cohort study.Scientific reports · 2022Article
- Gender Differences in Factors Associated with the Total Delay in Treatment of Pulmonary Tuberculosis Patients: A Cross-Sectional Study in Selangor, Malaysia.International journal of environmental research and public health · 2022Article
- Strengthening Tuberculosis Services for Children and Adolescents in Low Endemic Settings.Pathogens (Basel, Switzerland) · 2022Article
- The impact of ethnic minority status on tuberculosis diagnosis and treatment delays in Hunan Province, China.BMC infectious diseases · 2022Article
- Knowledge of symptoms and delays in diagnosis of extrapulmonary tuberculosis patients in North Shewa zone, Ethiopia.PloS one · 2022Article
- Health-seeking and diagnosis delay and its associated factors: a case study on COVID-19 infections in Shaanxi Province, China.Scientific reports · 2021Article
- Treatment delay in childhood pleural tuberculosis and associated factors.BMC infectious diseases · 2020Article
- Delays in health seeking, diagnosis and treatment for tuberculosis patients in Mongolia: an analysis of surveillance data, 2018-2021.Western Pacific surveillance and response journal : WPSARArticle
Corrections and comments
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Authors and funding
4 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDelays in treatment initiation for tuberculosis (TB) may lead to worse clinical outcomes and increased transmission. We aimed to determine factors associated with treatment delays, to guide public health action.
methodsWe extracted data on clinical characteristics and documented potential barriers to treatment from all pulmonary TB cases with clinical case review data from 2011 to 2015 and linked these to TB surveillance data. We described the distribution of delays from symptom onset to first presentation ("presentation delay") and from presentation to treatment ("healthcare delay"). We calculated time ratios (TRs) to determine the association between sociodemographic and clinical factors and delay outcomes.
resultsMedian presentation delay was 30 days (interquartile range (IQR) 11-72 days). Language barriers were associated with 40% longer presentation delay (TR 1.40, 1.01-1.94). Median healthcare delay was 40 days (IQR 13-89 days), and mostly consisted of the time taken before deciding to refer to TB specialists (median 26 days, IQR 4-73 days). Shorter healthcare delay was associated with positive sputum smear (TR 0.58, 0.47-0.70), UK residency <2 years (TR 0.47, 0.32-0.67), male sex (TR 0.74, 0.60-0.91) and secondary care referral (TR 0.63, 0.51-0.78).
conclusionsOur findings support continued initiatives to enable access to care for migrant populations to minimise presentation delay. Multifaceted approaches to increase clinician awareness of TB clinical presentations, to implement systems enabling early case recognition, to maximise the yield from sputum smear investigations and to ensure rapid diagnosis of smear negative cases are required to achieve further TB control.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.