Trial reportPloS one2021
Pathways to care and preferences for improving tuberculosis services among tuberculosis patients in Zambia: A discrete choice experiment.
Trial report in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- The Evolving Landscape of Discrete Choice Experiments in Health Economics: A Systematic Review.PharmacoEconomics · 2025Pooled it
- Predicted Preferences for Tuberculosis Point-of-Care Tests Among Tuberculosis-Affected Individuals in 5 High Burden Countries.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Tuberculosis screening and care delivery in pregnant and postpartum persons living with HIV in Botswana.PLOS global public health · 2026Article
- Informing People-Centered Target Product Profiles for TB Diagnostics: A Multi-Country Qualitative Study.medRxiv : the preprint server for health sciences · 2025Article
- Cardiovascular Involvement in Tuberculosis Patients Treated in Southern Africa.JACC. Advances · 2025Article
- Engagement of private health care facilities in TB management in Lusaka district of Zambia: lessons learned and achievements.BMC public health · 2024Article
- Person-centered strategies for delivering TB diagnostic services in Lima, Peru.Public health action · 2023Article
- A mixed methods study on men's and women's tuberculosis care journeys in Lusaka, Zambia-Implications for gender-tailored tuberculosis health promotion and case finding strategies.PLOS global public health · 2023Article
- A qualitative study of factors resulting in care delays for adults with meningitis in Zambia.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2022Article
- Patient Preferences for Strategies to Improve Tuberculosis Diagnostic Services in Zambia.JAMA network open · 2022Article
- Impact of early chest radiography on delay in pulmonary tuberculosis case notification in Ethiopia.International journal of mycobacteriologyArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundDelays in the diagnosis of tuberculosis (TB) contribute to a substantial proportion of TB-related mortality, especially among people living with HIV (PLHIV). We sought to characterize the diagnostic journey for HIV-positive and HIV-negative patients with a new TB diagnosis in Zambia, to understand drivers of delay, and characterize their preferences for service characteristics to inform improvements in TB services.
methodsWe assessed consecutive adults with newly microbiologically-confirmed TB at two public health treatment facilities in Lusaka, Zambia. We administered a survey to document critical intervals in the TB care pathway (time to initial care-seeking, diagnosis and treatment initiation), identify bottlenecks and their reasons. We quantified patient preferences for a range of characteristics of health services using a discrete choice experiment (DCE) that assessed 7 attributes (distance, wait times, hours of operation, confidentiality, sex of provider, testing incentive, TB test speed and notification method).
resultsAmong 401 patients enrolled (median age of 34 years, 68.7% male, 46.6% HIV-positive), 60.9% and 39.1% were from a first-level and tertiary hospital, respectively. The median time from symptom onset to receipt of TB treatment was 5.0 weeks (IQR: 3.6-8.0) and was longer among HIV-positive patients seeking care at a tertiary hospital than HIV-negative patients (6.4 vs. 4.9 weeks, p = 0.002). The time from symptom onset to initial presentation for evaluation accounted for the majority of time until treatment initiation (median 3.0 weeks, IQR: 1.0-5.0)-an important minority of 11.0% of patients delayed care-seeking ≥8 weeks. The DCE found that patients strongly preferred same-day TB test results (relative importance, 37.2%), facilities close to home (18.0%), and facilities with short wait times (16.9%). Patients were willing to travel to a facility up to 7.6 kilometers further away in order to access same-day TB test results. Preferences for improving current TB services did not differ according to HIV status.
conclusionsProlonged intervals from TB symptom onset to treatment initiation were common, especially among PLHIV, and were driven by delayed health-seeking. Addressing known barriers to timely diagnosis and incorporating patients' preferences into TB services, including same-day TB test results, may facilitate earlier TB care engagement in high burden settings.
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