Association of TB treatment initiation delay with clinical severity and risk of transmission among pulmonary tuberculosis patients in Tigray, Northern Ethiopia: Cross-sectional study

Abstract Background Delayed treatment initiation of tuberculosis (TB) increases disease progression and development of complications which may lead to a higher risk of transmission, clinical severity and increased mortality. But, published evidences that investigated the effect of delayed initiation of treatment on clinical severity and risk of transmission of pulmonary tuberculosis patients is scarce in Tigray, Northern Ethiopia. Objective To investigate the association of delayed treatment initiation of Pulmonary Tuberculosis with clinical severity and risk of transmission. Methods In this cross-sectional study design, a total of 875 newly diagnosed adult pulmonary tuberculosis patients were recruited from 21 health facilities from October 2018 to October 2019. Health facilities were selected by simple random sampling method and the study participants were enrolled consecutively. Data were collected using questionnaires through face-to-face interviews of patients within the first 2 weeks of treatment initiation. Clinical severity was assessed by Bandim tuberculosis score and risk of transmission was assessed by smear positivity or lung cavitations. Data were analyzed using SPSS version 21 software program. Logistic regression analysis was used to ascertain the association of delay with clinical severity and risk of transmission. P-value of less than 0.05 was reported as being statistically significant. Results Those who had initiating treatment without delay and those who were initiated treatment after a medium delay of 31 to 60 days were significantly associated with decreased clinical score compared to those who initiated treatment after a delay of more than two months. Compared with patients who were initiated treatment within one month, the risk of transmission was greater for delay of 30-60 days and above 60 days. Patients having more than 3 family members have higher risk to transmit TB as compared to those who have maximum of 3 family members. Whereas, patients having at least two rooms and being HIV negative have lower risk to transmit TB compared to their counter patients. Conclusion Narrowing the gap between initial occurrence of TB symptoms and treatment initiation is the way forward to improve clinical courses of TB patients and to reduce the risk of transmission of TB to other people from these patients.