Most studies of delayed tuberculosis diagnosis focus on the adverse effect of time elapsed between the onset of symptoms to reaching diagnosis and subsequent patient outcomes and control of community transmission.
A University of Georgia study takes a new angle on the issue and looks at the potential societal influence and prevention of diagnosis delay.
TB is an infectious bacterial disease that often attacks the lungs and affects eight million people worldwide and kills two million yearly. The largest public health hazard related to TB lies in patients’ inability to reach a quick diagnosis, as every step taken before seeking care from a TB provider represents potential transmission of the disease, according to the study’s lead author Dr. Juliet Sekandi, who previously practiced medicine and specializes in infectious diseases. She is now a postdoctoral research and teaching associate in the UGA College of Public Health.
Dr. Sekandi’s impetus for this specific research used the degrees of separation theory to study why practitioners see TB patients cycle through repeated diagnoses, defining each “degree” as a “step.” The study found that TB patients surveyed in Kampala, Uganda, circled through four separate steps while seeking health care before reaching proper diagnosis and successful treatment and that strong community networks are vital to speeding up the process.
“I had to move away from the clinic and into the community that the TB patients came from to ask why they are coming back even after they’ve been given effective TB treatment,” said Dr. Sekandi, who is under the mentorship of Christopher Whalen, the Ernest Corn Professor of Infectious Disease Epidemiology in the college’s department of epidemiology and biostatistics.
The study, published in the journal BioMed Central Infectious Diseases, used steps as the time variable as it calculated how long patients spent navigating throughout their social networks, community and health care providers.
The ideal number of steps is one, from a patient directly to a TB-care provider. However, the extensive and disparate network of the Ugandan health care landscape often results in patients cycling in and out of the health care system, seeing many providers who are not specialized in TB diagnosis or treatment, Dr. Sekandi said.
“Public health really needs the involvement of the patient, providers and the community,” Dr. Sekandi said.