Understanding where people with tuberculosis seek care to serve them better

In an ideal scenario, someone with chronic cough, fever, and weight loss would promptly seek care at a public tuberculosis clinic, be tested immediately for tuberculosis with a rapid molecular test and receive appropriate short-course tuberculosis therapy. They would receive social support to complete therapy without missing any doses and recover completely with no residual symptoms or post-tuberculosis lung syndrome. However, people with symptoms of tuberculosis typically delay seeking care for weeks due to factors such as low disease awareness, distance to facilities, self-medication, or age.¹ When they do seek care, they are likely to first visit local primary care providers in their neighbourhoods, including pharmacies and private practitioners, or informal providers, such as drug sellers and traditional healers.^1,2 Tuberculosis is rarely diagnosed on that first visit.³ What health systems typically record as “delayed care-seeking” often reflects initial symptom misattribution rather than patient inaction.¹ Studies in India, Indonesia, Kenya, and Nigeria done before and after the COVID-19 pandemic show patients have between two and eight visits before tuberculosis diagnosis, with extremes reaching 21 visits in highly fragmented systems.