Why does it take so long? The reasons behind Drug Resistant -Tuberculosis (DR-TB) treatment delay in Uganda

Background Tuberculosis (TB) persists globally despite effective medications, with drug-resistant strains complicating the situation. Challenges like patient adherence, lengthy treatment and delayed diagnoses contribute to treatment failures, especially in drug-resistant TB patients. The aim of the study was to investigate the socio-demographic, clinical, and structural factors associated with the timing of treatment initiation following DR-TB diagnosis among patients enrolled on DR-TB treatment in Uganda. Method Data from the Uganda National TB/Leprosy Program's national case registration database was used, with a sample size of 2,166 DR-TB patients, who completed treatment within a two-year follow-up period. Kaplan Meier survival curves, decrement life-tables and the discrete time-to-event analysis with logistic regression were used to examine the relationship between socio-demographic, clinical, and structural factors, and the timing of DR-TB treatment initiation following diagnosis. Results About fifty-seven percent of DR-TB patients experienced delays beyond the acceptable 7 days in treatment initiation, with an overall median time delay of 10 days. Patients with a previous treatment history of Lost to follow-up (Defaulter) and those in the failure category were less likely to initiate DR-TB treatment, whereas those in the ‘relapse category’, were more likely to initiate DR-TB treatment compared to the new DR-TB patients. Conclusion Thus, healthcare professionals in TB clinics need to be vigilant about DR-TB patients with previous treatment history and those in the failure category. In addition, future studies should endeavor to explore further the linkage between the sex of the patient, age of the patient, patient's HIV status, patient on ART & CPT, disease class, mode of treatment, and treatment initiation following diagnosis.