Patient pathway analysis of rifampicin-resistant TB diagnostic and treatment delays

BACKGROUND: Barriers to the diagnosis and treatment of rifampicin-resistant TB (RR-TB) have not been fully elucidated. This study aimed to map the diagnostic and treatment delays among patients with RR-TB in China and investigate related factors. METHODS: Between June and July 2023, the diagnostic and treatment pathways of patients with RR-TB were obtained through interviews at eight hospitals across China. Information on the TB service of hospitals was collected via telephone. RESULTS: Ninety-eight patients were included. On average, each patient required 4.6 visits to start RR-TB treatment. The median delay from illness onset to RR-TB treatment was 238.0 days (IQR 85.8-469.2), primarily driven by the delay between TB diagnosis and identifying rifampicin (RIF) resistance (median: 43.5 days, IQR 3.0-160.5). Referral to appropriate hospitals (adjusted hazard ratio [aHR] 2.32; 95% CI 1.37-3.92) or considering drug susceptibility testing (DST) when initiating treatment (aHR 2.56, 95% CI 1.39-4.72) significantly reduced delay between TB diagnosis and identifying RIF resistance, while stigma regarding TB (aHR 0.61, 95% CI 0.38-0.98) was an independent risk factor. CONCLUSIONS: Patients with RR-TB experienced substantial delays in identifying RIF resistance. Referring patients to hospitals with molecular DST capabilities and awareness may reduce these delays.