[Analysis and predictor of delays in the suspicion and treatment among hospitalized patients with pulmonary tuberculosis]

Correlates of Delayed Diagnosis among Human Immunodeficiency Virus-Infected Pulmonary Tuberculosis Suspects in a Rural HIV Clinic, South Africa

Background. Delay in pulmonary tuberculosis (PTB) diagnosis is one of the major factors that affect outcome and threatens continued spread of tuberculosis. This study aimed at determining factors associated with delayed PTB diagnosis among human immunodeficiency virus (HIV) infected individuals. Methods. A retrospective observational study was done using clinic records of HIV-infected PTB suspects attending an HIV/AIDS clinic at Tintswalo rural hospital in South Africa (SA) between January 2006 and December 2007. Using routine clinic registers, 480 records were identified. Results. PTB diagnosis delay was found among 77/176 (43.8%) of the patients diagnosed with PTB. The mean delay of PTB diagnosis was 170.6 days; diagnosis delay ranged 1–30 days in 27 (35.1%) patients, 31–180 days in 24 (33.8%) patients; 24 (31.2%) patients remained undiagnosed for ≥180 days. Independent factors associated with delayed diagnosis were: older age >40 years (Odds Ratio (OR) 3.43, 95% CI 1.45–8.08) and virological failure (OR 2.72, 95% CI 1.09–6.74). Conclusion. There is a considerable delayed PTB diagnosis among HIV-infected patients in rural SA. Older patients as well as patients with high viral load are at a higher risk of PTB diagnosis delay. Therefore efforts to reduce PTB diagnosis delay need to emphasised.

[Tuberculosis-related hospitalization in Spain: a cost analysis]

OBJECTIVE

To evaluate the number and cost of hospitalizations due to tuberculosis occurring in the Spanish National Health System (NHS) during 1999 to 2006.

METHODS

The specific diagnosis-related groups (DRG) for tuberculosis (DRGs 705, 709, 711 and 798-802) were analyzed.

RESULTS

We observed a striking decrease in hospitalizations (-25%), concomitant tuberculosis-HIV infection (-8.7%), and tuberculosis-related deaths (-0.5%, NS). In addition, there was a drop in the absolute number of hospital admissions and overall cost (from 31.3 to 30.8 and from 40.6 to 40.1 million euro), and a significant decrease in the relative hospitalizations and cost with respect to the overall number and hospital budget (from 0.21% to 0.10% and from 0.15% to 0.07%).

CONCLUSIONS

There is a marked decrease in tuberculosis-related hospitalizations and mortality, but the disease remains a considerable health burden.