Treatment delay and associated factors among adult Drug Resistant Tuberculosis patients at treatment initiating centers in  Amhara region, Ethiopia.

Kenaw Tegegne Tefera^1*, Nebiyu Mesfin², Mebratu Mitiku Reta², Malede Mequanent Sisay³

^, Koku Sisay Tamirat³, Temesigen Yehunie Akalu³

¹ University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia

² Department of Internal Medicine, School of Medicine, College of Medicine and Health   Sciences, University of Gondar, Gondar, Ethiopia

³ Department of Epidemiology and Biostatistics, Institute of Public Health College of   Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

* Corresponding author(presenting Author)

Kenaw tegegne

kenawtegegne@gmail.com

Background: Delayed initiation of tuberculosis treatment results in higher morbidity, mortality, and increased person-to-person transmission. The aim of this study was to assess treatment delay and its associated factors among adult drug resistant tuberculosis patients in Amhara Region, Ethiopia.

Methods: An institution based cross sectional study was conducted among all adult drug resistance tuberculosis patients who were initiated treatment from September 2010 to December 2017. Data were collected from patient chart, registration book, and computer data base using abstraction sheet. Data entered using Epi-info version 7 and exported to SPSS version 20 for analysis. Summary statistics like median was carried out. Binary logistic regression was fitted; adjusted odds ratio (AOR) with 95% CI was also computed. Variables with p-value less than 0.05 in the multi variable logistic regression model were considered as significantly associated with treatment delay.

Results: The median time to commence treatment after drug resistance tuberculosis diagnosis was 8 (IQR: 3-37) days. The prevalence of treatment delay was 48.3% [95% CI: 44.0%-52.8%]. Diagnosed by Line probe assay [AOR=5.59; 95% CI: 3.48- 8.98], Culture [AOR=5.15; 95% CI: 2.53-10.47], and history of injectable anti-TB drug [AOR=2.12; 95% CI: 1.41- 3.19] were found to be significant factors associated with treatment delay.

Conclusion: Considering the infectiousness of the disease, drug resistance tuberculosis treatment expected to be commenced immediately after diagnosis. However, in this study treatment delay was longer and nearly half of the patients experienced treatment delay. Prior history of injectable anti-TB drug and diagnostic modalities were significantly associated with treatment delay. This suggests that the need of universal accesses of rapid molecular diagnostic test such as, expert and it may be good to provide intensive health education especially for those who had previous history of injectable anti-TB drug.

Keywords: Drug resistant tuberculosis, Treatment delay, Amhara Region