Evaluation of timeliness of treatment initiation among smear positive pulmonary tuberculosis patients in Brong Ahafo Region, Ghana, 2015

Background: We evaluated timeliness and factors influencing treatment initiation (TI) among smear positive pulmonary tuberculosis (PTB+) patients in Brong Ahafo Region (BAR), Ghana. Design and Setting: We conducted a cross-sectional study in health facilities (HF) in six districts in BAR, from November 2014 to May 2015. Newly diagnosed smear positive PTB patients were selected randomly proportionate to size of facility cases. Timeliness of symptoms, diagnosis, TI and factors for delay were assessed using structured questionnaire. Patient delay was defined as presentation to a health care provider after 21 days of the onset of TBrelated symptoms and TI delay as therapy initiated after 30-days of onset of TB-related symptoms. We determined median patient timeliness, HF, and TI timeliness. We identified factors associated with TI delay using logistic regression. Results: There were a total of 237 PTB+ patients; median patient timeliness of 30 days (IQR:14, 60). The median health facility timeliness was 8 days (IQR:4, 10); and the median TI timeliness was 36 days (IQR:25, 69). Majority (58.7%) of patients delayed in seeking treatment. TI delay was associated with: Unemployment [aOR=7.4, 95%CI(1.9- 28.8)], fear of losing job [aOR=3.4, 95%CI(1.3-8.5)], traditional healer as first port of call [aOR=10.6, 95%CI(13.0- 66.8)], and initially being treated for HIV [aOR=4.9, 95%CI(1.6-14.8)]. Conclusion: There were delays in treatment initiation and patient treatment seeking timeliness. One-third of patients would prefer traditional healers/self-treatment/drug store as an option. A concerted effort by stakeholders is needed to improve behaviour change communication on good health seeking behaviour for persons living with TB to reduce delays in seeking treatment.