Influence of care pathways on the time of initiation of TB treatment

Untreated positive pulmonary TB smear has both individual implications, increasing morbidity and mortality, and collective implications, increasing the contagiousness of the disease. The present study aims to identify the course of patient care and the influence of care pathway on the time of initiation of TB treatment in Abidjan. We conducted a prospective and comparative study between two groups with pulmonary smear-positive: 38 with a conventional course (use of only the health facilities) and 198 with mixed driving (combining health facilities, self-medication and traditional medicine). The average time between onset of symptoms and initiation of treatment for patients with conventional path was significantly different from that observed in patients with mixed course (4.28 weeks versus 8.57 weeks, P < 0.001). Multivariate analysis mixed route was related to level of education (OR=2.728 [1.165-6.386]; P=0.02), the district of residence (OR=2.690 [1.168-6.195]; P=0.02), the mode of onset of symptoms (OR=0.33 [0.101-0.6607]; P=0.013) and weight loss (OR=0.259 [0.139-0.798]; P=0.004). The course of patients are multiple and can induce delays in starting treatment for tuberculosis. The sensitization of the population and the involvement of traditional healers in TB screening may contribute to the early therapeutic management.