PMC-2875696-sec-02__text
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2. Methods
We conducted a systematic study of patients hospitalized from August 2006 until September 2007 at the Yerevan City and the Republican Dispensaries, the two reference TB hospitals in Armenia. Following focus group discussions and pilot testing to refine the survey instrument, patient interviews began in the fall of 2006 and were conducted by trained students in the public health program of the American University of Armenia. Students received training by the study designer (SO) on principles of interview ethics and interviewing processes.
Most patient interviews were conducted at the Republican Dispensary in Abovian Marz, the national TB diagnostic and treatment facility to which all suspected cases throughout the country are referred for diagnostic confirmation. In the past several years, strong financial support has been provided to Armenia by a number of international organizations, such as the German Gesellschaft fur Technische Zusammenarbeit (GTZ), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Red Cross, which has enabled both microscopic and culture examinations for each TB case to be performed at the National Reference Laboratory located at the Republican TB Dispensary. All culture-confirmed TB cases are admitted as in-patients while undergoing the initial phase of therapy. Because all confirmed TB patients in Armenia are referred to one of these dispensaries for treatment, this population represents all known TB cases in the country. Therefore, all culture-confirmed TB in-patients present at the time of the interviewer visits were eligible for inclusion in the study (the study group included both new and relapsed patients). Our systematic sample of the inpatient TB population--in which interviewers visited every hospital room to identify patients willing to participate--yielded a participation rate of approximately 80% (a total of 240 patients).
Interviewers collected demographic information and asked each patient to recall when they first began to feel ill, what symptoms they experienced, how long after symptom onset they waited to see a doctor, their reasons for delaying medical evaluation, the type of facility at which they first sought care, the initial diagnosis, if they had been referred for further evaluation, and their adherence to treatment once diagnosed with TB. In 2006, 129 of the planned 250 surveys were completed. Data collection resumed in the fall of 2007 and a total of 240 interviews were conducted.

