Healthcare seeking pathways and delays for the diagnosis of tuberculosis and treatment initiation

Abstract

As a direct cause of the COVID-19 pandemic, all services that cater to individuals with tuberculosis (TB) have been disrupted (the Global Fund, 2021). In 24 countries surveyed across Africa, there was approximately a 28% reduction in case referrals (Stop TB Partnership, 2021). This means that almost a third of all people who should have been referred for further testing and diagnostics for suspected TB were missed. Nigeria’s healthcare sector is majorly driven by private providers (67%), and the private sector approximately administers 78% of total health expenditure (Stallworthy, 2020). However, the effect that COVID-19 is having on this already fragmented health care sector is unclear. It is imperative to investigate major changes in patient care-seeking behaviours. We designed surveys (interview style and quantitative questionnaire) to examine and quantify the delays caused by the COVID-19 pandemic that individuals in Nigeria are facing while trying to access diagnosis and treatment for TB in the private sector. The surveys were conducted with consenting individuals from Lagos and Kano, Nigeria, to gather information regarding the steps individuals with TB took while seeking care (screening, diagnosis, treatment), delays that they faced due to the pandemic, and direct and indirect costs of care. Data analysis is currently ongoing, but we have already found that 81% of all patients were able to access TB care within 2 visits to a healthcare provider, and a major challenge that patients faced was the increased cost in transportation, but overall willingness to seek care wasn’t affected by the COVID-19 pandemic.

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