Clinic presentation delay and tuberculosis treatment outcomes in the Lake Victoria region of East Africa: A multi-site prospective cohort study

Clinic presentation delay, defined as the time between symptom onset to presentation at a health facility, is a significant concern in these communities. A prospective cohort study was conducted to investigate the associations between clinic presentation delay and TB treatment outcomes in the Lake Victoria region. The study included 776 adults who initiated TB treatment at 12 public sector health facilities near Lake Victoria between 2018 and 2019. The study population was enumerated from health facility records, and demographic and clinical data were abstracted for members of the cohort. A subcohort of 301 members was recruited for face-to-face interviews to assess clinic presentation delay and additional variables not captured in routine records. The study found that clinic presentation delay was common, occurring in 54.7% of cohort members, with no specific correlates identified. Clinic presentation delay was slightly associated with unfavorable TB treatment outcomes, with a 14.2% risk of an unfavorable outcome among those with clinic presentation delay, compared to 12.7% among those presenting earlier. The study suggests that community-based interventions may be necessary to reduce clinic presentation delays in communities near Lake Victoria. The findings highlight the need for targeted strategies to address the complex barriers to healthcare access in these communities. The study was conducted at 12 public sector health facilities located near the shores of Lake Victoria, with facilities selected based on high volume of TB treatment, availability of Xpert MTB/RIF diagnostic testing, and capacity to initiate TB treatment. The study population included all adults who initiated TB treatment in the 6 months preceding data collection at the selected health facilities. The study team abstracted data from routine TB treatment records for all adults initiating TB treatment in a 6-month period across the 12 health facilities. The study also included a subcohort of 301 members recruited for face-to-face interviews to assess clinic presentation delay and additional variables not captured in routine records. The study found that clinic presentation delay was a significant concern in the Lake Victoria region, with 54.7% of cohort members experiencing a delay. The study also found that clinic presentation delay was slightly associated with unfavorable TB treatment outcomes, with a 14.2% risk of an unfavorable outcome among those with clinic presentation delay. The study was supported by the United States Agency for International Development (USAID) under the terms of the MEASURE Evaluation cooperative agreement. The study was conducted in partnership with the University of North Carolina at Chapel Hill, ICF International, John Snow, Inc., Management Sciences for Health, Palladium, and Tulane University.