Abstract
OBJECTIVES: The patient pathway of multidrug-resistant tuberculosis (MDR-TB) in China is an essential but not well-studied area. This study aimed to understand the alignment between patient-initiated care-seeking demands for MDR-TB and the availability of diagnostic and treatment services in Ningbo, a city in eastern China, using patient pathway analysis (PPA). METHODS: We collected the diagnostic and treatment data of 240 patients with MDR-TB in Ningbo from 2015 to 2019. Using patient pathway analysis, we matched the medical data of patients from different medical institutions and mapped their care pathways to illustrate their access to medical services. RESULT: Our study indicated that the proportion of patients with MDR-TB who chose non-TB-designated medical institutions (55%) was higher than those who chose TB-designated medical institutions (45%) at their initial visit. An estimated 69% of patients with MDR-TB patients received initial TB screening services during their first visit. In this study, 47% of patients needed to visit 4-7 medical institutions to be diagnosed with MDR-TB. Overall, 80% (n = 192) of patients were diagnosed with MDR-TB within four visits, while 13% (n = 30), 4% (n = 10), and 3% (n = 8) of patients were not diagnosed at the fourth visit and remained at level 2, 1, and 0 medical institutions, respectively. CONCLUSION: The care-seeking pathway of patients with MDR-TB in Ningbo is complex. This indicates room for improvement in local diagnosis and referral services. There is a need to promote the deployment of MDR-TB screening, diagnosis, and treatment services at lower-level institutions.