Ponticiello et al. (2001)
Monaldi Hospital, Naples, Italy
TB referral center for Campania
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Prospective cohort study
Level: III-2
Quality: 16/26
High risk of bias
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N=90 cases of TB
100% Caucasian
48 (53%) had cavity type lesion on chest X-ray
Average delay in diagnosis 2.25 ± 1.0 months
3 (2.7%) TST-negative
Contacts:
N=277 (out of 346 identified contacts)
44 did not comply with protocol
25 refused consent
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Inclusion
All patients with newly diagnosed pulmonary TB during the period January 1997 – December 1998 and their contacts (those sharing the same indoor environment for prolonged periods)
AFB in sputum or bronchial smear and positive culture for MTB
Exclusion
Patients with HIV and their contacts
No written informed consent
Failure to comply with study protocol
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Delay to diagnosis ≤ 1 month
Delay defined as period from onset of any TB symptoms to diagnosis
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Delay in diagnosis:
1.5 months
2.0 months
(also examines up to 5 months)
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Proportion of contacts TST-positive
Proportion of contacts TST-negative
Odds TST+/TST–
OR (TST+/TST–) Various lengths of delay compared with reference ≤ 1 month delay
Analysis of clinical risk factors
ORs and their 95%CIs were calculated by means of univariate and multivariate logistic regression
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Golub et al. (2006)
Maryland, USA
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Prospective cohort study
Level: III-2
Quality: 16/26
High risk of bias
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N=124 total patients with pulmonary TB included
34 excluded due to no contacts identified/tested
N=54 (44%) born in USA
US patients:
65% male
72% black
59% < 50 years of age
57% AFB sputum-positive
19% chest X-ray with cavitation
385 contacts, of whom 310 (81%) skin tested
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Inclusion
All verified pulmonary TB patients who reported to the Maryland Department of Health and Mental Hygiene between 1 June 2000 and 30 November 2001 and their close contacts
Close contacts included those living in the same household, working in a closed environment with patient, and reported close friends and relatives
Exclusion
No contacts identified or no contacts tested
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Treatment delay either:
≤ 60 days or
≤ 90 days
Delay treated as a dichotomous variable, analysed for cut-offs of 60 and 90 days
Total treatment delay defined as interval from first TB symptoms to initiation of treatment for TB
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Treatment delay > 60 days
Treatment delay > 90 days
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Number of contacts infected TST-positive (tested at baseline and 10–12 weeks later)
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Van der Oest, Kelly & Hood (2004)
Waikato Health District, New Zealand
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Retrospective cohort study
Level: III-2
Quality: 11/26
High risk of bias
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N=244 (189 new cases, 37 relapse cases, 18 unclassified):
52% male
110 (45%) Maori
46 (19%) non-Indigenous New Zealanders
81 (33%) born overseas, 40 of whom were refugees
number with length of diagnostic delay reported 152 (62% of cases)
outcome of treatment reported for 214 (88%) of cases
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Inclusion
All notified cases of TB who were residing in the Waikato Health District at the time of notification from 1 January 1992 to 31 December 2001
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No diagnostic delay
Delay defined as time between development of symptoms and notification/diagnosis of the case
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Increasing diagnostic delay
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Favourable treatment outcome as defined by WHO (i.e. cure or treatment completed)
Statistical analysis
Logistic regression was used for multivariate and univariate comparisons
Chi-square test
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