Health seeking behaviour and diagnosis for pulmonary tuberculosis in an HIV-epidemic mountainous area of Thailand

SETTING: Chiang Rai Hospital, Chiang Rai Province, the epicentre of the hum an immunodeficiency virus (HIV) in Thailand. OBJECTIVE: To describe the health seeking behaviour among tuberculosis (TB) patients, to measure patient and provider delays and to analyse factors de termining these delays. DESIGN: All patients aged over 15 years with new sm ear-positive pulmonary TB detected in Chiang Rai Hospital (n = 557) were in terviewed using a structured questionnaire. RESULTS: The median patient delays for HIV-positive and HIV-negative patien ts and those whose HIV status was unknown were 10, 15 and 15 days respectiv ely, while provider delays were respectively 7, 7.5 and 10 days. HIV-positi ve patients suffered more symptoms and had a shorter patient's delay. Risk factors of long patient delay (> 21 days) included being HIV-negative, havi ng no health insurance, hill tribe ethnicity, no previous visits to the hos pital, and borrowing money for hospital visits. Multivariate logistic analy sis suggested that being married or widowed and being HIV-positive led to t he shortest patient delay. Provider delay was significantly longer in femal e patients than male patients. CONCLUSION: Although patient and provider delays were favourably short, cer tain specific groups require further attention. Hill tribe people should be targeted to improve accessibility to TB treatment. Active case-finding ser vices for people known to be HIV-positive should be encouraged. The reasons for the longer provider delay in female patients require further investiga tion.