Determinants of tuberculosis diagnosis and the role of counselling

Objective: To study patient determinants that may affect completion of the diagnostic process in tuberculosis control, highlighting the role of counselling. Design: Cross-sectional study. Subjects: TB patients. Setting: Rhodes Chest Clinic, Nairobi, City Council. Results: Ninety five percent of the suspects delivered three sputum samples but only 7% consented to a HIV test; several determinants for none consenting were mentioned. On verage US$2.27 was spent for one clinic visit and US$8.62 for following the entire diagnostic process. Cost factors included transport, loss of income and food. Conclusion: Individual pre-test counselling seems important for obtaining three sputum specimens. It takes time and for settings with a large number of suspects, alternative methods may be required. To obtain consensus for a HIV test in a TB clinic is complicated. Costs spent on transport and loss in income are important determinants and may contribute to poor patient adherence to the diagnostic process.