{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T11:02:58Z","timestamp":1782126178179,"version":"3.54.5"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Significant progress has been made in reducing the tuberculosis (TB) rate in England over the last decade. South West England has a low incidence of TB, but over a third of people with pulmonary TB (pTB) had a treatment delay of over four months in 2020, higher than the England average. This study aimed to identify the exposures associated with presentation and healthcare delays in receiving pTB treatment in the South West of England between 2015 and 2020. This retrospective cohort study included all confirmed persons with TB resident in South West England, receiving treatment between 2015 and 2020. Univariate and multivariable Cox proportional hazards ratios were produced for the outcome measures of presentation and healthcare delays for persons with pTB. Multivariable regression models were fitted using a forward, stepwise procedure. Sensitivity analyses excluded treatment delays over two years and the year 2020. Data were analysed using Stata 17. Between 2015 and 2020 there were 812 persons with pTB among South West residents. Median treatment delays were 35 days for presentation and 25 days for healthcare delay. Multivariable analysis identified that longer presentation delays were associated with being aged 35\u201350 or over 80 years old. Longer healthcare delays were associated with increasing age (hazard ratio [HR]: 0.99, 95% CI: 0.98\u20130.99), being employed (HR: 0.71, 95% CI: 0.52\u20130.97) and people currently or historically deprived of their liberty and accommodated by a prison (HR: 0.33, 95% CI: 0.20\u20130.54). Shorter healthcare delays were associated with sputum smear positivity (HR: 1.54, 95% CI: 1.16\u20132.06) and smoking (HR: 1.64, 95% CI: 1.22\u20132.22). Delays between symptom onset and TB treatment remain an important public health problem in the region. Factors have been identified that can be investigated to reduce presentation and healthcare delays. Detailed analyses were valuable in disaggregating key populations. Further mixed-methods research would be warranted to further understand these associations.<\/jats:p>","DOI":"10.1371\/journal.pone.0340187","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T18:45:51Z","timestamp":1767811551000},"page":"e0340187","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Exposures associated with tuberculosis presentation and healthcare delays in South West England, 2015\u20132020"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6913-9148","authenticated-orcid":true,"given":"Gemma","family":"Lyness","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neville Q.","family":"Verlander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles R.","family":"Beck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"pone.0340187.ref001","volume-title":"Tuberculosis in England. 2021 report (presenting data to end 2020)","author":"UK Health Security Agency","year":"2021"},{"key":"pone.0340187.ref002","volume-title":"Tuberculosis in England, 2022 report (data up to end of 2021)","author":"UK Health Security Agency","year":"2023"},{"key":"pone.0340187.ref003","volume-title":"Tuberculosis incidence and epidemiology, England, 2023","author":"UK Health Security Agency","year":"2025"},{"key":"pone.0340187.ref004","volume-title":"Tuberculosis (TB): action plan for England, 2021 to 2026","author":"UK Health Security Agency, NHS","year":"2021"},{"key":"pone.0340187.ref005","volume-title":"The End TB Strategy","author":"World Health Organization (WHO)","year":"2015"},{"issue":"4","key":"pone.0340187.ref006","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1017\/S0950268808001118","article-title":"The influence of socio-economic deprivation on tuberculosis treatment delays in England, 2000-2005","volume":"137","author":"CE French","year":"2009","journal-title":"Epidemiol Infect"},{"issue":"1","key":"pone.0340187.ref007","doi-asserted-by":"crossref","DOI":"10.1183\/23120541.00161-2019","article-title":"Factors associated with delay in treatment initiation for pulmonary tuberculosis","volume":"6","author":"DJ Roberts","year":"2020","journal-title":"ERJ Open Res"},{"key":"pone.0340187.ref008","unstructured":"Office for National Statistics. Population estimates for the UK, England and Wales, Scotland and Northern Ireland, provisional: mid-2019. Office for National Statistics. 2020. Available from: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/populationandmigration\/populationestimates\/bulletins\/annualmidyearpopulationestimates\/mid2019"},{"key":"pone.0340187.ref009","unstructured":"Office for Health Improvement and Disparities. Health Profile of the South West of England 2021: Office for Health Improvement and Disparities. 2022 [cited 2022 Aug 18]. Available from: https:\/\/fingertips.phe.org.uk\/static-reports\/health-profile-for-england\/regional-profile-south_west.html"},{"key":"pone.0340187.ref010","volume-title":"Migration Observatory Regional Profile South West","author":"Migration Observatory","year":"2019"},{"key":"pone.0340187.ref011","unstructured":"UK Health Security Agency. Tuberculosis in the South West: 2021. 2021 report (presenting data to end of 2020). Bristol: UK Health Security Agency. 2022. Available from: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/1081817\/TB-south-west-2020-data.pdf"},{"key":"pone.0340187.ref012","volume-title":"Tuberculosis (TB): a resource to support TB in low incidence areas","author":"Public Health England","year":"2021"},{"key":"pone.0340187.ref013","unstructured":"National Institute for Health and Care Excellence (NICE). Tuberculosis. NICE Clinical Knowledge Summaries. National Institute for Health and Care Excellence (NICE). 2023. Available from: https:\/\/cks.nice.org.uk\/topics\/tuberculosis\/diagnosis\/diagnosis\/"},{"key":"pone.0340187.ref014","volume-title":"Notifying suspected or confirmed active tuberculosis (TB)","author":"UK Health Security Agency","year":"2025"},{"key":"pone.0340187.ref015","unstructured":"Health Protection Agency Centre for Infections. 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