Uncovering reasons for treatment initiation delays among children with TB in Lima, Peru

• Published in: The international journal of tuberculosis and lung disease 2020-12, Vol.24 (12), p.1254-1260
• Main Authors: Coit, J., Wong, M., Galea, J. T., Mendoza, M., Marin, H., Tovar, M., Chiang, S. S., Lecca, L., Franke, M. F.
• Format: Article
• Language: English
• Subjects: Adolescent; Barriers; Caregivers; Child; Child, Preschool; Children; Content analysis; Delay; Delayed Diagnosis; Diagnosis; Health services; Humans; Infant; Infant, Newborn; Pediatric Tuberculosis; Pediatrics; Peru - epidemiology; Physicians; Qualitative Research; Treatment Delay; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - drug therapy
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.20.0079

BACKGROUND: Timely diagnosis and treatment of pediatric tuberculosis (TB) is critical to reducing mortality but remains challenging in the absence of adequate diagnostic tools. Even once a TB diagnosis is made, delays in treatment initiation are common, but for reasons that are not well understood.METHODS: To examine reasons for delay post-diagnosis, we conducted semi-structured interviews with Ministry of Health (MoH) physicians and field workers affiliated with a pediatric TB diagnostic study, and caregivers of children aged 0-14 years who were diagnosed with pulmonary TB in Lima, Peru. Interviews were analyzed using systematic comparative and descriptive content analysis.RESULTS: We interviewed five physicians, five field workers and 26 caregivers with children who initiated TB treatment < 7 days after diagnosis (n = 15) or who experienced a delay of ≥7 days (n = 11). Median time in delay from diagnosis to treatment initiation was 26 days (range 7-117). Reasons for delay included: health systems challenges (administrative hurdles, medication stock, clinic hours), burden of care on families and caregiver perceptions of disease severity.CONCLUSION: Reasons for delay in treatment initiation are complex. Interventions to streamline administrative processes and tools to identify and support families at risk for delays in treatment initiation are urgently needed.