The identification of risk factors associated with patient and healthcare system delays in the treatment of tuberculosis in Tabriz, Iran.

BACKGROUND: Tuberculosis (TB) is a serious health concern, particularly in developing countries. Various delays, such as patient delay (PD) and healthcare system delay (HSD) in the TB process, are exacerbating the disease burden and increasing the rates of transmission and mortality in various global communities. Therefore, the aim of this study is to identify risk factors associated with PD and HSD in TB patients in Tabriz, Iran. METHODS: A cross-sectional study was conducted on 173 TB patients in Tabriz, Iran from 2012 to 2014. Patients were interviewed with a semi-structured questionnaire. Frequencies and percentages were reported for patient categories of sex, age, and education. The median and interquartile range (IQR) were reported for the time intervals of delays. Univariate and multivariate logistic regressions of delay in respect to socio-demographic and clinical variables were performed. Statistical significance was set at p < 0.05. RESULTS: The median values for delays were 53 days for HSD (IQR = 73) and 13 days for PD (IQR = 57). Odds ratios (OR) associated with PD were: employed vs. unemployed (OR = 5.86, 95% CI: 1.59 to 21.64); public hospitals vs. private hospitals (OR = 2.64, 95% CI: 1.01 to 6.85); ≥ 3 vs. < 3 visits to health facilities before correct diagnosis (OR = 2.35, 95% CI: 1.08 to 5.11); and male vs. female (OR = 2.28, 95% CI: 1.29 to 4.39). The OR associated with HSD were: ≥ 3 vs. < 3 visits to health facilities before correct diagnosis (OR = 9.44, 95% CI: 4.50 to 19.82), without vs. with access to TB diagnostic services (OR = 3.56, 95% CI: 1.85 to 6.83), and misdiagnosis as cold or viral infection vs. not (OR = 2.62, 95% CI: 1.40 to 4.91). CONCLUSIONS: The results provide for an important understanding of the risk factors associated with PD and HSD. One of the major recommendations is to provide more TB diagnostic knowledge and tools to primary health providers and correct diagnoses for patients during their initial visit to the health care facilities. The knowledge generated from this study will be helpful for prioritizing and developing strategies for minimizing delays, initiating early treatment to TB patients, and improving TB-related training programs and healthcare systems in Tabriz, Iran.

An Innovative Method to Enhance the Modified DOTS for TB Patients.

BACKGROUND: Nowadays establishing communication and educating patients to enhance their knowledge regarding disease and treatment process at home is one of the most important principles in providing patient care. MATERIALS AND METHODS: A semi-experimental study was done on 57 patients with active pulmonary tuberculosis in two care groups namely professional - family mix directly observed treatment short- course (PFM-DOTS) and family based-DOTS (FB-DOTS). The patients were referred to the tuberculosis and lung diseases research center for diagnosis and treatment of pulmonary tuberculosis. Both the patient and a family supervisor were evaluated regarding their level of knowledge of the disease and the treatment regimen. RESULTS: A significant difference between the degree of knowledge of groups of patients and the groups of family relatives before and after the intervention was indicated, with a higher increase in PFM-DOTS group than in F-B-DOTS group (P< 0.001). In PFM- DOTS group 100% of the patients, and in the FB-DOTS group 86.8% of the patients followed the recommended drug regimen (P<0.001). CONCLUSION: According to the treatment recommendations by the World Health Organization (WHO) for appropriate implementation of DOTS project combating TB, it seems the PFM-DOTS implementation is a more suitable method with greater effects on correct care and treatment of tuberculosis patients.

The Effectiveness of Family-Based DOTS versus Professional-Family Mix DOTS in Treating Smears Positive Tuberculosis.

BACKGROUND: The present study compared the effectiveness of Family-Based DOTS (FB-DOTS) versus Professional-Family Mix DOTS (PFM-DOTS) in smear positive tuberculosis (TB) patients. METHODS: This semi-experimental study was performed in Tuberculosis and Lung Diseases Research Center of Tabriz in 2011-2012, among 57 TB patients recruited into either FB-DOTS or PFM-DOTS groups. At the baseline of the study, knowledge of both patients and their supervisors were assessed while at the end point, smear and culture of sputum, quality of life, knowledge and satisfaction of the patients along with the knowledge and satisfaction of their supervisors were assessed. RESULTS: The difference for sputum smear negative (culture) was 16.2 (4.8%) and 7.7(6.9%) for the PFM-DOTS in comparison with FB DOTS by the end of the second and forth months of treatment, respectively. A significant difference was observed between the two groups in relation to knowledge, satisfaction (patients and supervisors) and all four domains of quality of life: physical health (P=0.036), psychological health (P<0.001), social relations (P=0.026) and environmental health (P<0.001). CONCLUSION: The PFM-DOTS treatment strategy in which health experts follow the patients in their homes seems to be among most appropriate strategies in treating TB.

Validity and Reliability of the Iranian Version of the HIV/AIDS Stigma Instrument-PLWHA (HASI-P).

BACKGROUND: HIV/AIDS disease has remained highly stigmatized all over the world even though the increasing accessibility of its treatment. This study was designed to adapt the HIV/AIDS Stigma Instrument (HASI) to the Iranian People Living with HIV/AIDS (PLWHA). METHODS: Translation -back translation of the scale into Persian was done. Then, the validity and reliability of the instrument were evaluated. The validity of the translated scale was assessed in three ways: evaluating its linguistic validity, assessing its content validity by a panel of nine experts, and exploring its construct validity by factor analysis. The internal con-sistency of the translated scale was evaluated by Cronbach's Alpha. RESULTS: HASI showed a good Content Validity Index (CVI value >0.75) and Content Validity Ratio (CVR >0.78). The internal consistency of the instrument regarding the total score was α=0.89. The three stigma sub-scales that were dis-tancing and blaming (8 items, α=0.87), fear (3 items, α=0.82), and discrimination (5 items, α=0.83). CONCLUSION: This article reports the development and validation of a new measure of stigma, i.e. HIV/AIDS Stigma Instrument in PLWHA (HASI-P), and pro-vides evidence to support its content validity and internal consistency.