Delays in the diagnosis and treatment of newly diagnosed tuberculosis patients in Kampala, Uganda between July 2021 and June 2022: a cross-sectional study

Uganda’s TB case detection rate remains below the WHO target, and delays in diagnosis and treatment sustain community transmission. Evidence from high-burden urban settings such as Kampala is limited, and earlier Ugandan studies preceded the expanded rollout of rapid WHO-recommended molecular and antigen diagnostics. We assessed the extent of, and factors associated with, these delays among patients with newly diagnosed TB in Kampala. We conducted a cross-sectional study (July 2021–June 2022) among adults with newly diagnosed, microbiologically confirmed pulmonary TB, recruited by multistage sampling from 10 health facilities across the five divisions of Kampala District and interviewed using a pre-tested structured questionnaire. Diagnostic, treatment and total delays were defined as self-reported intervals exceeding 14, 2 and 16 days, respectively. Analyses were performed in Stata version 14. Univariate analysis summarised participant characteristics as frequencies, percentages and medians with interquartile ranges (IQR). Bivariate associations were assessed using chi-squared tests for categorical variables, Student’s t-test or the Wilcoxon rank-sum test for continuous variables as appropriate, and crude prevalence ratios. Variables with p < 0.20 were entered into multivariable modified Poisson regression with robust standard errors to estimate adjusted prevalence ratios (aPR) with 95% confidence intervals (CI). Statistical significance was set at p < 0.05. Of 368 participants (median age 35 years, IQR 27–43; 59.0% male), 60.1% reported a TB episode in the previous 12 months. Diagnostic, treatment and total delays occurred in 58.2%, 20.7% and 61.7%, respectively; median diagnostic and treatment delays were 30 days and 1 day. Diagnostic delay was associated with previous TB (aPR 1.78, 95% CI 1.46–2.18), first consulting a private facility (aPR 1.27, 1.06–1.53), self-reported severe illness (aPR 1.27, 1.02–1.58), current smoking (aPR 1.23, 1.01–1.51) and good TB knowledge (aPR 1.31, 1.12–1.54), and was less likely among HIV-positive participants (aPR 0.82, 0.69–0.96). Treatment delay was associated with peri-urban residence (aPR 2.16, 1.42–3.30), previous TB (aPR 1.61, 1.02–2.57) and current smoking (aPR 1.86, 1.18–2.95). Diagnostic delay is the principal bottleneck to timely TB care in Kampala. Interventions should target diagnosis in the private sector and provide financial support and targeted education for people with a previous TB episode.