Data from: Durations and delays in care seeking, diagnosis and treatment initiation in uncomplicated pulmonary tuberculosis patients in Mumbai, India

Background: Timely diagnosis and treatment initiation are critical to reduce the chain of transmission of Tuberculosis (TB) in places like Mumbai, where almost 60% of the inhabitants reside in overcrowded slums. This study documents the pathway from the onset of symptoms suggestive of TB to initiation of TB treatment and examines factors responsible for delay among uncomplicated pulmonary TB patients in Mumbai. Methods: A population-based retrospective survey was conducted in the slums of 15 high TB burden administrative wards to identify 153 self-reported TB patients. Subsequently in-depth interviews of 76 consenting patients that fit the inclusion criteria were undertaken using an open-ended interview schedule. Mean total, first care seeking, diagnosis and treatment initiation duration and delays were computed for new and retreatment patients. Patients showing defined delays were divided into outliers and non-outliers for all three delays using the median values. Results: The mean duration for the total pathway was 65 days with 29% of patients being outliers. Importantly the mean duration of first care seeking was similar in new (24 days) and retreatment patients (25 days). Diagnostic duration contributed to 55% of the total pathway largely in new patients. Treatment initiation was noted to be the least among the three durations with mean duration in retreatment patients twice that of new patients. Significantly more female patients experienced diagnostic delay. Major shift of patients from the private to public sector and non-allopaths to allopaths was observed, particularly for treatment initiation. Conclusion: Achieving positive behavioural changes in providers (especially non-allopaths) and patients needs to be considered in TB control strategies. Specific attention is required in counselling of TB patients so that timely care seeking is effected at the time of relapse. Prioritizing improvement of environmental health in vulnerable locations and provision of point of care diagnostics would be singularly effective in curbing pathway delays.**背景**：及时诊断与启动治疗对于降低结核病（Tuberculosis, TB）的传播链至关重要，在孟买这类地区尤为如此——当地近60%的居民居住在过度拥挤的贫民窟中。本研究记录了从疑似结核病症状发作到启动抗结核治疗的完整就诊路径，并分析了孟买地区单纯性肺结核患者出现就诊延迟的相关影响因素。 **方法**：本研究在15个高结核病负担行政辖区的贫民窟内开展基于人群的回顾性调查，共纳入153名自我报告的结核病患者。随后，针对符合纳入标准且签署知情同意的76名患者，采用开放式访谈提纲进行深入访谈。分别计算初治与复治患者的总就诊时长、首次就医时长、诊断时长及治疗启动时长，并统计各类延迟情况。以中位数为界，将出现明确延迟的患者按三类延迟分别划分为异常值组与非异常值组。 **结果**：患者的总就诊路径平均时长为65天，其中29%的患者属于异常值组。值得注意的是，初治患者（24天）与复治患者（25天）的首次就医平均时长无显著差异。诊断时长占总就诊时长的55%，这一情况在初治患者中尤为突出。治疗启动时长是三类环节中最短的，而复治患者的治疗启动平均时长为初治患者的两倍。女性患者出现诊断延迟的比例显著更高。研究还观察到，患者从私立医疗机构流向公立医疗机构、从非对抗疗法医师（non-allopaths）转向对抗疗法医师（allopaths）的现象尤为显著，这在治疗启动环节中表现最为突出。 **结论**：结核病防控策略应考虑推动医疗服务提供者（尤其是非对抗疗法医师）与患者的行为正向改变。需对结核病患者提供针对性的咨询服务，确保其在复发时能够及时就医。优先改善脆弱地区的环境卫生，并提供即时诊断（point of care diagnostics）服务，将可有效遏制就诊路径延迟问题。