The city of Porto Alegre in southern Brazil had a rate of incidence of TB in 104 cases/100,000 inhabitants/year in 2011. Brazil is ranked 17 th among 22 countries, and has the highest reported incidence of TB, with 42 cases/100,000 inhabitants in 2011. Eight million people develop active disease each year, resulting in 2 million deaths from TB annually. Approximately 2 billion people, representing one third of the world’s population, are infected with TB. Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis and remains a public health problem worldwide. Our study shows substance abuse programs need to be aware of control of TB, with health interventions focusing on TB education programs. The main factor associated with patient delay is drug abuse (crack and cocaine). Patient delay appears to be the main problem in this city with a high prevalence of TB in Brazil. The factors that were independently associated with health care system delay (time ≥ 18 days) were weight loss (OR = 2.76, p = 0.025), miliary pattern (OR = 5.33, p = 0.032), and fibrotic changes (OR = 0.12, p = 0.013) on chest X-ray.
The factors that were independently associated with patient delay (time ≥ 30 days) were crack (odds ratio = 4.88, p = 0.043) and cocaine (OR = 6.68, p = 0.011) use. The median total time of delay, patient delay, and health care system delay were 60 (interquartile range : 30–90.5 days), 30 (lQR: 7–60 days), and 18 (IQR: 9–39.5 days) days, respectively. We evaluated the delay in time until diagnosis and identified factors associated with delayed diagnosis (patient and health care system delays). The consenting patients meeting our inclusion criteria were interviewed using a pre-tested questionnaire. New TB patients ≥ 14 years diagnosed with pulmonary TB at the emergency department of Hospital de Clínicas de Porto Alegre were prospectively recruited between February 2010 and January 2012. This was a prospective study in a general, tertiary care, university-affiliated hospital of a city with a high prevalence of TB in Brazil. The present study aimed to investigate the delay in diagnosis of TB patients at the emergency department. However, many patients are still diagnosed late with TB at hospitals. Control of tuberculosis (TB) depends on early diagnosis and treatment at the primary health care level.