abstract: 'Multi-drug resistant tuberculosis (MDR-TB) represents a threat to health

  and development in countries with high TB burden. China''s MDR-TB

  prevalence rate of 6.8\% is the highest in the world. Interventions to

  remove barriers against effective TB control, and prevention of MDR-TB

  are urgently needed in the country. This paper reports a cross-sectional

  questionnaire survey of 513 pulmonary TB (PTB) patients, and qualitative

  interviews of 10 healthcare workers (HCWs), and 15 PTB patients. The

  objective was to assess barriers against effective control of PTB and

  prevention of MDR-TB by elucidating the perspectives of patients and

  healthcare providers. Results showed that more than half of the patients

  experienced patient delay of over 12.5 days. A similar proportion also

  experienced detection delay of over 30 days, and delay in initiating

  treatment of over 31 days. Consulting a non-TB health facility >= 3

  times before seeking care at TB dispensary was a risk factor for both

  detection delay {[}AOR (95\% CI): 1.89(1.07, 3.34) and delay in

  initiating treatment{[}AOR (95\% CI): 1.88 (1.06, 3.36). Results

  revealed poor implementation of Directly Observed Therapy (DOT), whereby

  treatment of 34.3\% patients was never monitored by HCWs. Only 31.8\%

  patients had ever accessed TB health education before their TB

  diagnosis. Qualitative data consistently disclosed long patient delay,

  and indicated that patient''s poor TB knowledge and socioeconomic

  barriers were primary reasons for patient delay. Seeking care and being

  treated at a non-TB hospital was an important reason for detection

  delay. Patient''s long work hours and low income increased risk for

  treatment non-adherence. Evidence-based measures to improve TB health

  seeking behavior, reduce patient and detection delays, improve the

  quality of DOT, address financial and system barriers, and increase

  access to TB health promotion are urgently needed to address the

  burgeoning prevalence of MDR-TB in China.'
affiliation: 'Li, Y (Corresponding Author), Third Mil Med Univ, Dept Social Med \&
  Hlth Serv Management, Chongqing, Peoples R China.

  Li, Ying; Liu, Ying, Third Mil Med Univ, Dept Social Med \& Hlth Serv Management,
  Chongqing, Peoples R China.

  Ehiri, John, Univ Arizona, Mel \& Enid Zuckerman Coll Publ Hlth, Div Hlth Promot
  Sci, Tucson, AZ USA.

  Oren, Eyal, Univ Arizona, Mel \& Enid Zuckerman Coll Publ Hlth, Div Epidemiol \&
  Biostat, Tucson, AZ USA.

  Hu, Daiyu; Wang, Qingya, Chongqing Inst TB Prevent \& Treatment, Chongqing, Peoples
  R China.

  Luo, Xingneng, Ctr Dis Control Shapingba Dist, Dept TB Control, Chongqing, Peoples
  R China.

  Li, Daikun, Chongqing Med Univ, Univ Town Hosp, Dept Lab Med, Chongqing, Peoples
  R China.'
article-number: e88330
author: Li, Ying and Ehiri, John and Oren, Eyal and Hu, Daiyu and Luo, Xingneng and
  Liu, Ying and Li, Daikun and Wang, Qingya
author-email: lilyliying2012@163.com
author_list:
- family: Li
  given: Ying
- family: Ehiri
  given: John
- family: Oren
  given: Eyal
- family: Hu
  given: Daiyu
- family: Luo
  given: Xingneng
- family: Liu
  given: Ying
- family: Li
  given: Daikun
- family: Wang
  given: Qingya
da: '2023-09-28'
doi: 10.1371/journal.pone.0088330
files: []
issn: 1932-6203
journal: PLOS ONE
keywords-plus: 'MULTIDRUG-RESISTANT TUBERCULOSIS; ANTITUBERCULOSIS-DRUG-RESISTANCE;

  RISK-FACTORS; PULMONARY TUBERCULOSIS; EPIDEMIOLOGY; PREVALENCE; DELAYS;

  TIME'
language: English
month: FEB 5
number: '2'
number-of-cited-references: '46'
orcid-numbers: Oren, Eyal/0000-0001-7817-3516
papis_id: 4b826a6b979a356127bb915a643da864
ref: Li2014arewe
researcherid-numbers: 'Oren, Eyal/AAD-5561-2019

  '
times-cited: '17'
title: Are We Doing Enough to Stem the Tide of Acquired MDR-TB in Countries with High
  TB Burden? Results of a Mixed Method Study in Chongqing, China
type: article
unique-id: WOS:000330829200177
usage-count-last-180-days: '0'
usage-count-since-2013: '26'
volume: '9'
web-of-science-categories: Multidisciplinary Sciences
year: '2014'