The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #68372

Yael Hirsch-Moverman, MPH¹, Debargha Sanyal, MPH¹, Paul W. Colson, PhD¹, and Wafaa M. El-Sadr, MD, MPH². (1) Charles P. Felton Nat. TB Ctr., Harlem Hospital Center, 2238 Fifth Ave., First Floor, New York, NY 10037, (212) 939-8240, yh154@columbia.edu, (2) Division of Infectious Diseases, Mailman School of Public Health at Columbia Universtiy and Harlem Hospital, Harlem Hospital 506 Lenox Avenue, 506 Lenox Avenue, Room 3101A, New York, NY 10037

Rationale: Delays in diagnosis of TB disease continues to be an issue of concern. Reasons for delays include: misinterpretation of symptoms by patients, lack of knowledge about healthcare resources available, and inaccurate diagnosis by providers. An examination of various paths to care can assist with the earlier identification of patients with TB disease, thereby decreasing risk of transmission. Methods: Patients were asked about the various providers and other sources of care who were consulted prior to formal TB diagnosis using structured questionnaire. All participants were patients with TB disease, with interviews conducted within two months of TB diagnosis. Results: To date, fourteen Harlem Hospital patients with TB disease have completed the questionnaire. Their mean age was 42 y.o., 64% were male, 93% were black, and 36% were foreign-born. Average time between onset of symptoms and TB diagnosis was 3.4 months. Nine respondents felt the reason people do not seek help immediately is because they "don't think it is serious" enough to consult provider. Seven patients (50%) consulted one or more providers or other individuals prior to seeing the provider who gave them their TB diagnosis. Foreign-born patients consulted 2.2 sources of care to reach TB diagnosis and US-born 1.3 sources of care. In several cases, over-the-counter remedies such as "Robitussin" and "Nyquil" were recommended to treat TB-related symptoms. Discussion: Foreign-born patients tend to have more complex paths to diagnosis. Continued investigation of help seeking behavior of patients with TB disease can provide valuable insight into reducing delays in TB diagnosis.

Learning Objectives:

• Recognize factors leading to delays in diagnosis of TB
• Identify other sources of care for TB diagnosis
• Discuss the impact of these delays on TB control

Keywords: Health Behavior, Tuberculosis

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.