Sex disparities in tuberculosis suspect evaluation: a cross-sectional analysis in rural Uganda

SETTING: Six primary health care centers in rural Uganda. OBJECTIVE: To compare the quality of tuberculosis (TB) evaluation for men and women presenting to primary health care facilities in high-burden settings. DESIGN: Cross-sectional study using indicators derived from the International Standards of Tuberculosis Care (ISTC) to compare the quality of TB evaluation services provided to men and women. RESULTS: Of 161 230 patient visits between January 2009 and December 2010, 112 329 (69.7%) were women. We considered 3308 (2.1%) patients with cough ≥2 weeks as TB suspects, of whom 1871 (56.6%) were women. Female TB suspects were less likely to be referred for sputum smear examination (45.9% vs. 61.6%, P < 0.001), to complete sputum smear examination if referred (73.7% vs. 78.3%, P = 0.024) and to receive comprehensive evaluation and care as defined by the ISTC (33.0% vs. 45.6%, P < 0.001). After adjusting for age, clinic site and visit date, women remained less likely to be referred for sputum smear examination (risk ratio [RR] 0.81, 95%CI 0.74-0.89, P < 0.001) and to receive ISTC-recommended care (RR 0.79, 95%CI 0.72-0.86, P < 0.001). CONCLUSION: Strategies to ensure that women receive appropriate TB evaluation could provide a valuable opportunity for increasing case detection while also promoting equitable and universal access to care.