Delays in tuberculosis care among the top-ten-tuberculosis-high burden countries in the world: a scoping review.

BACKGROUND

Delayed diagnosis and treatment can be detrimental not only to patients but also to the community, as such delays can perpetuate TB transmission. This presents a significant challenge in the ongoing efforts to eliminate TB from the community. The primary objectives of this scoping review were to map out research surrounding delays in TB care across the ten countries with the highest TB burden globally and to identify research gaps in this area.

METHODS

The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) were adhered to in reporting this scoping review. Three databases: PubMed, DOAJ, and Scopus, were searched to collect articles published between 2004 and 2024, all in the English language. A total of eighty-one articles were included in this review.

RESULTS

Out of 831 articles, following the eligibility criteria, 81 full-text open-access articles were deemed suitable for review. The findings indicate that delays in TB care are influenced by several factors, including patient-related, household and social, health system, economic, and occupational factors, as well as health-seeking behaviour. Significant variations in delay duration were observed across the reviewed studies. Myanmar recorded the longest median total delay of 170.6 days, while India and China reported median total delays ranging from 8 to 111 days. Due to resource constraints, Mozambique experienced the highest median health system delay of 150 days. There were a very limited number of studies conducted in the Democratic Republic of Congo, the Philippines, and Zambia.

CONCLUSION

This scoping review found that delays in TB care in high-burden countries are influenced by a combination of patient, social, economic, and health-system factors, with significant differences in delay durations between different countries. These findings underscore the need for stronger health systems, targeted community education to encourage timely care-seeking, and stigma-reduction efforts to minimise delays and support TB elimination goals.