{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T20:39:27Z","timestamp":1791664767043,"version":"4.3.4"},"reference-count":26,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2015,7,26]],"date-time":"2015-07-26T00:00:00Z","timestamp":1437868800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"COMDIS Health Service Delivery Research Programme Consortium (COMDIS HSD)"},{"name":"UK Department for International Development"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Shandong Province has implemented the standardised treatment of multidrug\u2010resistant tuberculosis (<jats:styled-content style=\"fixed-case\">MDR<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content>) supported by the Global Fund. The study aimed to understand the managements and delays of patients with <jats:styled-content style=\"fixed-case\">MDR<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> before initiating their treatments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All patients with <jats:styled-content style=\"fixed-case\">MDR<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> who had completed intensive phase treatment from January 2010 to May 2012 were interviewed using a structured questionnaire. Delays and treatments were analysed. Diagnosis delay is defined as the period between having sputum smear results and drug susceptibility test (<jats:styled-content style=\"fixed-case\">DST<\/jats:styled-content>) results. Treatment delay was defined as starting <jats:styled-content style=\"fixed-case\">MDR<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> treatment more than 2\u00a0days after receiving the diagnosis of <jats:styled-content style=\"fixed-case\">MDR<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content>. Total delay is the sum of diagnosis delay and treatment delay.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 110 patients with <jats:styled-content style=\"fixed-case\">MDR<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> participated in the study. Median delay for diagnosis was 102\u00a0days. Over 80% of patients had a diagnosis delay longer than 90\u00a0days. <jats:styled-content style=\"fixed-case\">MDR<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> treatments commenced after a median of 9\u00a0days after <jats:styled-content style=\"fixed-case\">DST<\/jats:styled-content> results, and over 37% of the patients with <jats:styled-content style=\"fixed-case\">MDR<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> experienced treatment delays. Chronic cases or patients with indifferent attitude had significantly longer treatment delay than other groups (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.03 and 0.03, respectively). During their delays, of 44 patients with retreatment failures, 12 (27.3%) were treated through adding single <jats:styled-content style=\"fixed-case\">second line drugs (SLD<\/jats:styled-content>s) to first\u2010line regimens, and 25 (56.8%) were treated with first\u2010line drugs. A high proportion of initial treatment failure\/relapsed\/returned cases (37%) and new cases (43%) were administered with <jats:styled-content style=\"fixed-case\">SLD<\/jats:styled-content>s.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Most of the patients with <jats:styled-content style=\"fixed-case\">MDR<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> experienced prolonged diagnosis delay, which was the most important factor contributing to the total delay. Misuse of <jats:styled-content style=\"fixed-case\">SLD<\/jats:styled-content>s during the days was common, so necessary training should be given to prevent irrational prescription of medications.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12566","type":"journal-article","created":{"date-parts":[[2015,7,14]],"date-time":"2015-07-14T13:07:00Z","timestamp":1436879220000},"page":"1431-1437","source":"Crossref","is-referenced-by-count":24,"title":["Diagnostic and treatment delays of multidrug\u2010resistant tuberculosis before initiating treatment: a cross\u2010sectional study"],"prefix":"10.1111","volume":"20","author":[{"given":"Xiulei","family":"Zhang","sequence":"first","affiliation":[{"name":"Center for TB Control Shandong Provincial Chest Hospital Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Yin","sequence":"additional","affiliation":[{"name":"School of Public Health and Primary Care Chinese University of Hong Kong Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haitao","family":"Li","sequence":"additional","affiliation":[{"name":"Center for TB Control Shandong Provincial Chest Hospital Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuguang","family":"Li","sequence":"additional","affiliation":[{"name":"Center for TB Control Shandong Provincial Chest Hospital Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Walley","sequence":"additional","affiliation":[{"name":"Nuffield Centre for International Health and Development University of Leeds Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanyang","family":"Zou","sequence":"additional","affiliation":[{"name":"Nuffield Centre for International Health and Development University of Leeds Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhitong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Nuffield Centre for International Health and Development University of Leeds Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolin","family":"Wei","sequence":"additional","affiliation":[{"name":"School of Public Health and Primary Care Chinese University of Hong Kong Hong Kong China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,7,26]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Guidelines for the Programmatic Management of Drug\u2010Resistant Tuberculosis","author":"World Health Organization","year":"2008"},{"key":"e_1_2_7_3_1","volume-title":"Guidelines for Treatment of Tuberculosis","author":"World Health 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