Delhi and Faridabad Drug-Resistant TB Patients Face Diagnostic and Treatment Delays

Between October 2021 and June 2022, a mixed-methods study conducted at three District Drug-Resistant TB Centres in Delhi and Faridabad revealed that 60.1% of drug-resistant tuberculosis patients experienced diagnostic delays exceeding 15 days, while 33.5% faced treatment initiation delays past seven days.

Drug-resistant tuberculosis continues to represent a severe hurdle for global health elimination frameworks. As reported by cureus.com, worldwide cases of multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB) reached approximately 390,000 in 2024, with 32% of this global disease burden located in India.

Evaluating the DR-TB Care Pathway in North India

Under India’s National Tuberculosis Elimination Programme (NTEP), diagnostic delay is classified as a turnaround time of over 15 days from the point a patient is eligible for drug susceptibility testing to actual confirmation, whereas treatment initiation delay is characterized by a span exceeding seven days from diagnosis to the start of therapy. The study evaluated 158 newly registered patients across Delhi and Haryana. Researchers found a median diagnostic turnaround duration of 24 days, accompanied by an interquartile range spanning from 7 to 67 days. Meanwhile, the median treatment initiation turnaround time stood at 5 days, ranging from 3 to 11 days.

The use of line probe assays was linked to diagnostic delays in multivariate logistic regression models, which displayed an adjusted odds ratio of 6.6. In contrast, utilizing cartridge-based nucleic acid amplification tests (CBNAAT) showed an inverse relationship with delays, resulting in an adjusted odds ratio of 0.2. Treatment initiation delays showed distinct geographical boundaries. Individuals living in Faridabad experienced a likelihood of delayed treatment initiation that was more than triple that of their Delhi counterparts, presenting an adjusted odds ratio of 3.1. Pediatric or adolescent patients aged 18 years and younger faced elevated probabilities of delayed treatment commencement, marked by an adjusted odds ratio of 6.4.

Systemic Bottlenecks and Qualitative Barriers

Deep-seated operational roadblocks were uncovered through qualitative insights gathered via in-depth interviews with 16 programme officials alongside 16 patients or caregivers. Participants pointed to insufficient CBNAAT availability, intermediate reference laboratory backlogs, and persistent societal stigma. Flawed tracking systems for private-to-public referrals frequently trapped individuals in lengthy care-seeking cycles before they finally arrived at designated district centers.

Prolonged intervals before treatment initiation compound clinical risks significantly. According to the data, delayed therapeutic intervention is linked to a greater than two-fold rise in mortality odds, alongside elevated sputum smear grades and the promotion of secondary resistance to anti-tubercular pharmaceutical compounds. Extending the time to treatment simultaneously prolongs the period of infectivity, increasing community transmission of drug-resistant strains.

Patients described the heavy toll of managing their healthcare. Programme officials echoed these systemic concerns regarding laboratory access and infrastructure constraints.

A DOTS Coordinator noted that not all tuberculosis units have CBNAAT/TrueNAT machines, with samples sent to intermediate reference laboratories facing backlogs and reagent shortages during the COVID-19 pandemic.

Private sector engagement remains a critical vulnerability in the pathway. A Senior Treatment Supervisor noted that patients often arrive with CBNAAT reports but lack understanding of their diagnosis, as private facilities sometimes fail to clearly communicate DR-TB status. Addressing these referral gaps and expanding point-of-care molecular testing capacity at peripheral units remain essential steps for curbing diagnostic delays across the region.