Delays in treatment initiation among drug-resistant tuberculosis patients in Southern Ethiopia treatment initiating centers: retrospective registry-based study

Introduction Delays in treatment initiation among drug-resistant tuberculosis (DR TB) patients contribute to complications, treatment failure, mortality, and continued disease transmission in the community. Objectives The objective of this study is to assess the magnitude and determinants of delayed treatment initiation among DR-TB patients receiving care at treatment-initiating centers (TICs) in Southern Ethiopia. Methods A health facility-based retrospective registry-based study was conducted among 237 confirmed drug-resistant tuberculosis (DR-TB) patients registered at four treatment-initiating centers (TICs) in Southern Ethiopia between June 28, 2019, and June 27, 2022. Eligible patients with documented confirmation dates and treatment initiation dates were included. Data were extracted from patient charts using KoboToolbox and analyzed in SPSS. Time to treatment initiation was measured from the date of DR-TB laboratory confirmation to the date of anti-DR-TB therapy initiation. Delayed initiation was operationalized as > 8 days. Bivariable and multivariable binary logistic regression analyses were conducted to identify independent factors associated with treatment initiation delay, reported as Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI). Results Among the 237 patients included in the analysis, the median time from laboratory confirmation of DR-TB to treatment initiation was 7 days (IQR: 4–21 days). Using the study-specific threshold of more than 8 days, 49.8% ( n = 118) were classified as having a longer interval to treatment initiation. Waiting for baseline investigations and DST results was the most frequently reported reason associated with the longer interval (89.8%). In multivariable logistic regression, rural residence (AOR = 3.68, 95% CI: 1.62–8.39), history of TB relapse (AOR = 5.70, 95% CI: 2.40–13.54), severe acute malnutrition (AOR = 2.56, 95% CI: 1.22–5.34), and moderate acute malnutrition (AOR = 3.28, 95% CI: 1.36–7.92) were significantly associated with increased odds of delay. Conversely, previous treatment with first-line anti-TB drugs (AOR = 0.16, 95% CI: 0.04–0.62), presence of comorbidities (AOR = 0.18, 95% CI: 0.06–0.54), and lower formal education levels were associated with lower odds of delay. Conclusion Approximately half of the DR-TB patients experienced prolonged time to treatment initiation. Delays were driven by rural geographic barriers, history of disease relapse, malnutrition, and health-system bottlenecks surrounding baseline laboratory testing turnaround times. To accelerate treatment initiation, health authorities should decentralize baseline diagnostic testing, strengthen linkage/referral protocols for rural and malnourished patients, and streamline pre-treatment laboratory workflows at TICs.