Tuberculosis Diagnostic Delays in Indonesian Primary Care Pathways

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Services Research

Background:

• Timely tuberculosis diagnosis is critical for reducing transmission and morbidity.
• Primary health centers in Indonesia play a key role in tuberculosis screening and diagnosis.
• Delays in tuberculosis diagnosis can occur even after patients enter formal care.

Purpose of the Study:

• To quantify diagnostic delay in presumptive tuberculosis cases within Indonesian primary care.
• To identify factors associated with diagnostic delay, tuberculosis diagnosis, and treatment initiation.

Main Methods:

• Facility-based, register-based observational study using national presumptive tuberculosis register data.
• Data collected from a primary health center in Tasikmalaya City, West Java, Indonesia (Jan-Dec 2025).
• Statistical analysis included negative binomial and logistic regression to assess factors associated with delay and outcomes.

Main Results:

• Median diagnostic delay was 4 days; 19.3% of cases experienced delays >14 days.
• Factors associated with longer delays included older age (≥65 years), extrapulmonary disease, and referral from another facility.
• 35.0% of presumptive cases were diagnosed with tuberculosis, and 89.8% of those diagnosed initiated treatment.

Conclusions:

• Most diagnostic results were timely, but delays disproportionately affected specific patient groups.
• Strengthening register tracking, referral feedback, and escalation pathways can improve tuberculosis care continuity.
• Targeted interventions are needed for older adults, extrapulmonary tuberculosis cases, and referred patients to ensure equitable care.