Prescribed and self-medication use increase delays in diagnosis of tuberculosis in the country of Georgia

INADEQUATE FUNDING, poverty, malnutrition, large numbers of internally displaced persons and collapse of the public health infrastructure following the breakup of the Soviet Union have all contributed to a resurgence of tuberculosis (TB) in the country of Georgia.1 In 2010, the incidence rate of TB in Georgia remained high, at 107 cases per 100 000 population.2 Georgia has also been designated one of the 27 high multidrug-resistant TB (MDR-TB) burden countries by the World Health Organization (WHO); in 2009, MDR-TB prevalence in Georgia was 10% in newly diagnosed patients and 31% in patients previously treated for TB.2 To enhance TB control, Georgia became one of the first middle-income countries to achieve universal access to diagnosis and treatment of TB, including MDR-TB, beginning in 2008. An assessment of the timely and proper utilization of these services is important to maximize their impact. The early detection and diagnosis of TB have been identified as a major priority of global TB control efforts.3 It is estimated that an untreated acid-fast bacilli (AFB) smear-positive TB case infects an average of 10 close contacts.4 Delays in TB diagnosis result in patients being infectious for prolonged periods of time and further transmission of Mycobacterium tuberculosis among exposed susceptible contacts. Diagnostic delays of TB have been investigated in many parts of the world; however, total delays and risk factors for delay vary significantly from region to region, likely due to differences in culture and infrastructure.4-6 No studies to date have evaluated delays in TB diagnosis in Georgia, and limited data exist on diagnostic delays from former Soviet republics. We sought to quantify delays in TB diagnosis and study risk factors for delays in an effort to target future public health interventions aimed at enhancing TB control in Georgia.