Diagnostic delay, expenditure pattern and treatment outcome of extra-pulmonary TB patients of Bangalore Urban...

The diagnosis of Extrapulmonary TB(EPTB) has always been a challenge for health care providers as it generally requires resource and greater clinical expertise. Timely detection and proper treatment of TB are the key elements of an effective TB control program. Our aim in this study is to determine the diagnostic delay and the factors associated with delay, to estimate the out of pocket expenditure, and the treatment outcome in Extrapulmonary TB Patients.

A mixed method study was carried out in Five TB Units of Bangalore Urban District on the newly diagnosed Extrapulmonary TB Patients of the last quarter of 2021. Data from registers and telephonic interviews were used to collect information for the quantitative data and the qualitative assessment was done through In-depth interviews.

Out of 174 patients, 44.2% had a diagnostic delay of more than 1 month. The average expenditure among the subjects for diagnosis and treatment was estimated to be ₹ 56,681. 63% of the patients incurred an expenditure of above ₹ 10,000 before diagnosis and 18.9% had incurred an expenditure above ₹ 10,000 during treatment. 16.7% were lost to follow up, 0.6% were declared cured and 82.2% as treatment completed. In-depth interviews of 30 randomly selected patients with diagnostic delay was done to explore the reasons for delay, which were manually coded to generate the following codes-lack of awareness of symptoms and delayed referral, neglected symptoms and self medication, atypical presentation, misdiagnosis, wrong choice of diagnostic procedure, co-morbidities with overlapping symptoms, incidental finding, ignorance about Government facilities and free TB treatment, and absent or mild symptoms/slow progression of symptoms.

Guidelines for diagnosis and treatment of EPTB to health care workers and public awareness about EPTB and provisions of Government facilities needs further emphasis. This will help reduce diagnostic delay of EPTB and its financial burden on the patients thereby ensuring better treatment completion and cure rate aiding in TB elimination.