Delays to tuberculosis treatment: shall we continue to blame the victim? [editorial]

Delayed diagnosis and treatment of pulmonary tuberculosis (PTB) entail increased transmission since patients are contagious until effective chemotherapy is started. Health education on ‘TB signs and symptoms’ is often advocated in order to reduce delays and increase case detection under the hypothesis that ‘lack of knowledge about TB’ determines care seeking among patients. The only published literature review on the subject of delays to TB treatment is based on qualitative studies and concludes that ‘the main reasons for delayed presentation of TB are a lack of understanding about TB the stigma associated with the disease the inaccessibility of treatment and a preference for private practitioners’ (in that order). Quantitative studies to measure delays to TB treatment rely on interviews of diagnosed patients. Of 13 such studies published between 1995 and 2004 in the International Journal of Tuberculosis and Lung Diseases a leading journal in the field of tuberculosis 10 include ‘improving awareness of TB in the community’ amongst their recommendations for reducing long delays to TB treatment. Does patients’ ‘lack of knowledge of TB’ indeed substantially contribute to long delays to TB treatment compared to other factors and should ‘awareness of the disease be increased in the community’ for more effective and successful tuberculosis control? The evidence for this is actually rather weak. (excerpt)