Furthermore, in 2014, the WHO reported that alcohol use in India has increased in the last five years. Other studies in India have found risky alcohol use in 40% of all males who consume alcohol and 52% of all male TB patients who consume alcohol. The World Health Organization (WHO) estimated that 25% of the country’s men have consumed alcohol in the past year. Previous studies have shown that hazardous alcohol use is prevalent in India. More work is needed to understand factors associated with delay in the private and public sectors which include the time it takes patients to enter the health system and how long until they are started on TB treatment. A study of standardized patients found that only 21% of the cases were properly managed by private healthcare providers. Patients often follow a circuitous route to diagnosis including self-medication and consulting private practitioners which often results in delayed diagnosis and treatment initiation. However, a recent study found that more than a quarter of prevalent TB patients are never evaluated at RNTCP clinics and review of drug sales show that this number is likely even higher.
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The Revised National TB Control Programme (RNTCP) offers free TB diagnosis and treatment to patients in public clinics. Patients can obtain healthcare through public and private clinics or a mix of both. One potential component of delay is the disconnect between different healthcare systems. However other studies found no association with income and alcohol use. Previous studies have found that longer delay is associated with factors including income, substance abuse, location of first seeking care, and distance to health care facility among others. Īlthough there have been several studies in India of predictors of delay in seeking care, results have been mixed and are likely setting-specific in such a large heterogeneous country. Untreated, TB patients spread infection and increase their own mortality risk. Reducing TB incidence will require a multi-pronged approach including efforts to decrease time to accessing care. In 2015 there were 2.8 million incident tuberculosis (TB) cases in India, comprising 27% of the 10.4 million global estimated TB cases. Further studies will be needed to determine why patients with higher income delay in seeking care. Local TB programs should consider that risky alcohol users may delay seeking care for TB. TB knowledge was not significantly associated with delay. Delay was less likely in lower versus higher income groups (10,000 rupees/month, aOR 0.31, 95% CI: 0.12, 0.78). In multivariable analysis, risky alcohol use was significantly associated with delay (aOR 2.20, 95% CI: 1.31, 3.68). Of 501 TB patients, 369 (73.7%) subjects delayed seeking care. TB knowledge was assessed by knowing transmission mode or potential curability. Risky alcohol use was defined by the AUDIT-C score which incorporates information about regular alcohol use and binge drinking. Delay was defined as cough ≥4 weeks before treatment initiation. Data were collected on demographic characteristics, symptom duration, and TB knowledge, among other factors. We analyzed data from newly diagnosed, smear-positive, culture-confirmed, pulmonary TB patients in the Regional Prospective Observational Research for TB (RePORT) cohort in Puducherry and Tamil Nadu, India. This study aimed to identify factors associated with delays in seeking care for TB in Southern India. Reducing delay to accessing care is necessary to reduce the Tuberculosis (TB) burden in high incidence countries such as India.
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