Determinants of tuberculosis diagnosis delay

<b>Introduction:</b> Early diagnosis of tuberculosis (TB) is essential to achieve cure and to reduce disease transmission. Total diagnostic delay (TDD) can be divided in patient delay (PD - from symptoms onset to seeking a health care facility) and health system delay (HSD - from first contact to confirmation of TB diagnosis). In Portugal, the median TDD is 80 days. This study aimed to identify risk factors associated with PD and HSD in a portuguese center. <b>Methods:</b> Cross-sectional study of patients diagnosed with pulmonary TB between 2011 and 2021. Demographic, clinical, microbiological and radiological data at time of diagnosis were analyzed. <b>Results:</b> Of the 130 patients included, 102 (78.5%) were male and 33 (25.4%) had &gt;60 years (mean age of 49.4 years). History of previous TB infection was present in 7 (5.4%) patients and 15 (11.5%) had known contact with a TB patient. The mean and median TDD were respectively 68.0/48 days, with 18.3/8 days due to PD and 49.7/25.6 days due to HSD. TDD was ≤30 days in 38 (29.2%) patients. Health system delay was more frequent in patients with &gt;60 years (p=0.043) and chronic diseases (p=0.043). Other factors associated with higher HSD were negative acid-fast bacilli smear (p&gt;0.001), localized pulmonary disease (p&gt;0.001) and absence of cavitation (p=0.014). Patient delay was higher if patients reported constitutional symptoms without respiratory complaints (p&gt;0.001). Patients with history of prior treatment or TB contact did not seek medical attention earlier. <b>Conclusion:</b> Delay in diagnosis is still a major challenge of TB control. This study highlights the need to maintain a high level of suspicion in all patients who seek health care and to educate the population in regard to TB symptoms and transmission.