An effective tuberculosis (TB) control program requires early diagnosis and immediate initiation into treatment to reduce transmission.  In 2011, recognizing this fact, the USAID funded TB CARE II Project developed a framework for analyzing TB delay along with a set of tools to collect data on patient delays. TB CARE II then conducted field assessments using these tools in two high-burden TB countries— Bangladesh and Swaziland—in order to identify specific factors causing delay.

The project has compiled the knowledge gained from these field assessments into a newly published Toolkit to Address Timely TB Case Detection and Treatment.  The purpose of this toolkit is to provide local TB and health program managers step-by-step assistance in understanding and identifying the possible reasons why people with TB symptoms delay in getting diagnosed and treated for TB.  Additionally, the toolkit provides guidance on interventions to address these delays, emphasizing the importance of utilizing a patient-centered approach to care.

This hands-on toolkit is composed of an easy-to-read description of why patients delay seeking TB care, diagnosis, and treatment initiation and that obstacles to delay include patients, communities, providers, and the health system itself.  The toolkit provides a visual planning tool for TB program managers to assess where the barriers causing delay are and for selecting appropriate interventions.  In addition, it provides practical assessment tools to measure causes of delay among different audiences (TB patient, TB health care provider, health facility manager, and NTP/district level manager) as well as health clinic registers from the first signs and symptoms of TB to treatment initiation.

It is our hope that this toolkit has been implemented in TB CARE II countries so that country-level action plans can be developed to address TB delays effectively.