Determinants of delays in the tuberculosis care pathway and adverse treatment outcomes in Chennai, South India: A retrospective cohort study

Background

Tuberculosis (TB) remains significant public health issue in India, particularly in high-burden areas. Understanding factors associated with adverse treatment outcomes and delays in TB care pathway is crucial for improving TB control efforts. Hence, this study aimed to identify the determinants of delay in TB care pathway and adverse treatment outcomes in Chennai, South India.

Methods

We conducted retrospective cohort study among 497 newly diagnosed, drug-sensitive TB patients at ESIC Medical College & PGIMSR, Chennai, from April 2020 to April 2022. Data were collected from the National TB Elimination Programme portal and supplemented via phone interviews. Patients were assessed for sociodemographic, behavioral, and clinical characteristics, and delays in TB care cascade. Logistic regression models identified predictors of patient delay, total delay, non-adherence, and adverse treatment outcomes and interpreted as adjusted odds ratio (AOR).

Results

The study found median patient delay of 18 days and total delay of 28 days in TB care pathway. Females and patients without fever at baseline had significantly longer delays. Extrapulmonary TB was associated with longer total delay. Non-adherence to medication was prevalent (26.6 %) and was the strongest predictor of adverse treatment outcomes (AOR:39.18, 95 %CI: 21.56–71.20, p < 0.001).

Conclusion

Our study found significant delays in care-seeking, especially among females and individuals without fever at baseline. Non-adherence to treatment was prevalent and associated with adverse treatment outcomes. Implementation of community-based adherence support programs that include regular patient follow-ups and counseling sessions will address barriers to treatment adherence, especially tailored for women and individuals with extrapulmonary TB.