Tuberculosis Diagnostic Delays in Indonesian Primary Care Pathways

Background: Timely tuberculosis diagnosis is essential for reducing transmission, preventable morbidity, and inequitable losses across the care cascade. In Indonesia, primary health centres are central to screening and diagnostic coordination, but delays may still occur after individuals with presumptive tuberculosis enter formal care. Objective: To quantify post-registration diagnostic delay among people with presumptive tuberculosis in Indonesian primary care and identify demographic, clinical, and referral-pathway factors associated with delayed results, tuberculosis diagnosis, and treatment initiation. Methods: We conducted a facility-based, register-based observational study using national presumptive tuberculosis register data from a primary health centre in Tasikmalaya City, West Java, Indonesia, covering 1 January to 31 December 2025. Diagnostic delay was defined as the interval from presumptive tuberculosis registration to the first recorded diagnostic result. Negative binomial regression estimated adjusted incidence rate ratios for delay, and logistic regression estimated adjusted odds ratios for prolonged delay, final diagnosis, and treatment initiation. Findings: Among 503 presumptive tuberculosis episodes, 486 had complete delay data. Median diagnostic delay was 4 days (interquartile range, 1-11 days). Delays longer than 14 and 30 days occurred in 94 episodes (19.3%) and 37 episodes (7.6%), respectively. Longer delay was associated with age 65 years or older (adjusted incidence rate ratio, 1.46; 95% CI, 1.12-1.90), extrapulmonary disease (1.58; 95% CI, 1.21-2.07), and referral from another health facility (1.35; 95% CI, 1.01-1.82). Overall, 176 presumptive episodes (35.0%) resulted in a tuberculosis diagnosis; 158 diagnosed patients (89.8%) had documented treatment initiation. Conclusions: Although most diagnostic results were recorded rapidly after registration, delays were concentrated among older adults, people with extrapulmonary disease, and referred patients. Strengthening register-based tracking, referral feedback, and escalation pathways for extrapulmonary tuberculosis may improve equitable continuity across primary care tuberculosis services.