{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:51:40Z","timestamp":1791204700476,"version":"4.2.0"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Being harmful to patients, delayed diagnosis and treatment can spread tuberculosis (TB) in the community, posing a significant challenge to TB elimination efforts. This systematic review and meta-analysis aimed to estimate the median delays of TB care and the proportion of the Indian population experiencing these delays.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Data extraction and screening were conducted from August 1, 2024, to September 30, 2024, using PubMed, Scopus, and DOAJ search engines. The pooled proportion of the Indian population experiencing the total delay in TB care was estimated, at a 95% confidence interval (CI), using a random-effects model that assumed potential heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of the 14 studies, 92.85% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 13) focused on drug-sensitive TB cases, and 7.15% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1) focused on drug-resistant cases. Similarly, 64.28% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 9) of studies were cross-sectional, followed by 21.42% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 3) of retrospective studies. The estimated median patient delay is 20.5 days (interquartile range [IQR]: 15.3\u201325.0), the median diagnosis delay is 32.5 days (IQR: 30.0\u201337.0), the median treatment delay is 7.50 days (IQR: 2.75\u201312.8), and the median total delay is 45.5 days (IQR: 37.1\u201358.5). The pooled proportion of the Indian population experiencing total delay is estimated at 39% (95% CI: 17%\u201364%). With the random-effects model, high heterogeneity (I2 = 99%) was observed among the studies. The regression test for funnel plot asymmetry did not show statistical significance (z = 0.204,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.838).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The findings of this study can help program managers design strategies that can help in reducing delays in TB care in India.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jgid.jgid_203_25","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:00:32Z","timestamp":1786370432000},"page":"134-145","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Delays in Tuberculosis Care in the Indian Population: A Systematic Review and Meta-analysis"],"prefix":"10.4103","volume":"18","author":[{"given":"Janmejaya","family":"Samal","sequence":"first","affiliation":[{"name":"International Institute of Health Management Research, New Delhi, India"},{"name":"School of Public Health, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. S.","family":"Preetha","sequence":"additional","affiliation":[{"name":"International Institute of Health Management Research, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hari","family":"Singh","sequence":"additional","affiliation":[{"name":"School of Public Health, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"R1-20261005","year":"2020","journal-title":"World Health Organization. Global Tuberculosis Report 2024. Geneva"},{"key":"R2-20261005","year":"2021","journal-title":"Central TB Division. India TB Report 2024. New Delhi"},{"key":"R3-20261005","article-title":"Ministry of Health and Family Welfare. National Strategic Plan for Tuberculosis: 2017-25 Elimination by 2025. New Delhi","year":"2017"},{"key":"R4-20261005","doi-asserted-by":"crossref","first-page":"469","DOI":"10.47203\/IJCH.2020.v32i03.001","article-title":"Tuberculosis control programme from NTCP to RNTCP to NTEP","volume":"32","author":"Bhardwaj","year":"2020","journal-title":"Indian J Community Health"},{"key":"R5-20261005","doi-asserted-by":"crossref","first-page":"e1002754","DOI":"10.1371\/journal.pmed.1002754","article-title":"Constructing care cascades for active tuberculosis: A strategy for program monitoring and identifying gaps in quality of care","volume":"16","author":"Subbaraman","year":"2019","journal-title":"PLoS Med"},{"key":"R6-20261005","doi-asserted-by":"crossref","first-page":"3275","DOI":"10.2147\/RMHP.S322143","article-title":"Contributing factors in the tuberculosis care cascade in India: A systematic literature review","volume":"14","author":"Yasobant","year":"2021","journal-title":"Risk Manag Healthc Policy"},{"key":"R7-20261005","first-page":"24","article-title":"Delayed tuberculosis diagnosis and tuberculosis transmission","volume":"10","author":"Golub","year":"2006","journal-title":"Int J Tuberc Lung Dis"},{"key":"R8-20261005","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.ijsu.2010.02.007","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"8","author":"Moher","year":"2010","journal-title":"Int J Surg"},{"key":"R9-20261005","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.jclinepi.2022.10.009","article-title":"Deduplicating records in systematic reviews: There are free, accurate automated ways to do so","volume":"152","author":"Guimar\u00e3es","year":"2022","journal-title":"J Clin Epidemiol"},{"key":"R10-20261005","first-page":"1","article-title":"The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses","volume":"2","author":"Peterson","year":"2011","journal-title":"Ott Ott Hosp Res Inst"},{"key":"R11-20261005","doi-asserted-by":"crossref","DOI":"10.1111\/jre.13405","article-title":"Risk of bias evaluation of cross-sectional studies: Adaptation of the Newcastle-Ottawa Scale","author":"Carra","year":"2025","journal-title":"J Periodontal Res"},{"key":"R12-20261005","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.ajodo.2019.12.003","article-title":"The importance of careful selection between fixed-effect and random-effects models","volume":"157","author":"Spineli","year":"2020","journal-title":"Am J Orthod Dentofacial Orthop"},{"key":"R13-20261005","doi-asserted-by":"crossref","first-page":"S60","DOI":"10.4103\/ijph.ijph_1079_22","article-title":"Diagnostic and treatment delay among new pulmonary tuberculosis patients in Southern India: A cross-sectional study","volume":"66","author":"Balasubramnian","year":"2022","journal-title":"Indian J Public Health"},{"key":"R14-20261005","doi-asserted-by":"crossref","first-page":"1015024","DOI":"10.3389\/fpubh.2023.1015024","article-title":"Why and where?-Delay in tuberculosis care cascade: A cross-sectional assessment in two Indian states, Jharkhand, Gujarat","volume":"11","author":"Yasobant","year":"2023","journal-title":"Front Public Health"},{"key":"R15-20261005","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1186\/s12879-017-2629-9","article-title":"Predictors of delayed care seeking for tuberculosis in Southern India: An observational study","volume":"17","author":"Van Ness","year":"2017","journal-title":"BMC Infect Dis"},{"key":"R16-20261005","doi-asserted-by":"crossref","first-page":"e0152287","DOI":"10.1371\/journal.pone.0152287","article-title":"Durations and delays in care seeking, diagnosis and treatment initiation in uncomplicated pulmonary tuberculosis patients in Mumbai, India","volume":"11","author":"Mistry","year":"2016","journal-title":"PLoS One"},{"key":"R17-20261005","doi-asserted-by":"crossref","first-page":"e39040","DOI":"10.1371\/journal.pone.0039040","article-title":"Factors associated with delays in treatment initiation after tuberculosis diagnosis in two districts of India","volume":"7","author":"Paul","year":"2012","journal-title":"PLoS One"},{"key":"R18-20261005","first-page":"569","article-title":"Pulmonary tuberculosis in mumbai, India: Factors responsible for patient and treatment delays","volume":"3","author":"Tamhane","year":"2012","journal-title":"Int J Prev Med"},{"key":"R19-20261005","doi-asserted-by":"crossref","first-page":"643","DOI":"10.4103\/2249-4863.222052","article-title":"Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Kerala","volume":"6","author":"Paramasivam","year":"2017","journal-title":"J Family Med Prim Care"},{"issue":"Suppl 1","key":"R20-20261005","doi-asserted-by":"crossref","first-page":"S172","DOI":"10.1016\/j.ijmyco.2016.09.056","article-title":"Delay in diagnosis among pulmonary tuberculosis patients of Rayagada District, Odisha, India","volume":"5","author":"Das","year":"2016","journal-title":"Int J Mycobacteriol"},{"key":"R21-20261005","doi-asserted-by":"crossref","first-page":"377","DOI":"10.4103\/ijph.IJPH_26_19","article-title":"Reasons for the delay in the initiation of treatment and initial default among drug-resistant tuberculosis patients in Ahmedabad corporation area","volume":"63","author":"Bhagyalaxmi","year":"2019","journal-title":"Indian J Public Health"},{"key":"R22-20261005","first-page":"1","article-title":"Factors associated with delay in treatment-seeking among new Sputum Smear, positive pulmonary tuberculosis patients registered under DOTS Centre, Nahan, Himachal Pradesh, India: A cross-sectional study","volume":"11","author":"Kashyap","year":"2022","journal-title":"Glob J Med Public Health"},{"key":"R23-20261005","first-page":"366","article-title":"Risk factors associated with delays in seeking treatment and diagnosis of tuberculosis patients at DOTS center of a tertiary care institute in Himachal Pradesh","volume":"15","author":"Singh","year":"2022","journal-title":"Med J DY Patil Univ"},{"key":"R24-20261005","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.jegh.2017.08.001","article-title":"Pulmonary tuberculosis in Patna, India: Durations, delays, and health care seeking behaviour among patients identified through household surveys","volume":"7","author":"Mistry","year":"2017","journal-title":"J Epidemiol Glob Health"},{"key":"R25-20261005","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.4269\/ajtmh.20-1297","article-title":"Diagnostic pathways and delays in initiation of treatment among newly diagnosed tuberculosis patients in Ballabgarh, India","volume":"104","author":"Chandra","year":"2021","journal-title":"Am J Trop Med Hyg"},{"key":"R26-20261005","doi-asserted-by":"crossref","first-page":"e0213345","DOI":"10.1371\/journal.pone.0213345","article-title":"Patient characteristics, health seeking and delays among new sputum smear positive TB patients identified through active case finding when compared to passive case finding in India","volume":"14","author":"Shewade","year":"2019","journal-title":"PLoS One"},{"key":"R27-20261005","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1016\/S0140-6736(19)32476-6","article-title":"Reduce the delay in tuberculosis diagnosis in India","volume":"394","author":"Ray","year":"2019","journal-title":"Lancet"},{"key":"R28-20261005","first-page":"789","article-title":"Factors associated with patient and health system delays in the diagnosis of tuberculosis in South India","volume":"6","author":"Rajeswari","year":"2002","journal-title":"Int J Tuberc Lung Dis"},{"key":"R29-20261005","first-page":"5","article-title":"Delay in DOTS for new pulmonary tuberculosis patient from the rural area of Wardha District, India","volume":"9","author":"Bawankule","year":"2010","journal-title":"Online J Health Allied Sci"},{"key":"R30-20261005","doi-asserted-by":"crossref","first-page":"255","DOI":"10.5588\/ijtld.13.0585","article-title":"Delays in diagnosis and treatment of pulmonary tuberculosis in India: A systematic review","volume":"18","author":"Sreeramareddy","year":"2014","journal-title":"Int J Tuberc Lung Dis"},{"key":"R31-20261005","first-page":"1","article-title":"Delay in diagnosis of pulmonary tuberculosis: A survey in the Lazio region, Italy","volume":"12","author":"Pezzotti","year":"2015","journal-title":"Epidemiol Biostat Public Health"},{"key":"R32-20261005","first-page":"992","article-title":"Patient and health care system delays in pulmonary tuberculosis diagnosis in a low-incidence state","volume":"9","author":"Golub","year":"2005","journal-title":"Int J Tuberc Lung Dis"},{"key":"R33-20261005","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1016\/S0140-6736(00)03241-4","article-title":"Health-seeking behaviour of individuals with a cough of more than 3 weeks","volume":"356","author":"Thorson","year":"2000","journal-title":"Lancet"},{"key":"R34-20261005","first-page":"324","article-title":"Tuberculosis patients and practitioners in private clinics in India","volume":"2","author":"Uplekar","year":"1998","journal-title":"Int J Tuberc Lung Dis"},{"key":"R35-20261005","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.4103\/jfmpc.jfmpc_1246_23","article-title":"Reasons and extent of delay in the diagnosis of pulmonary tuberculosis after the appearance of symptoms","volume":"13","author":"Ahmad","year":"2024","journal-title":"J Family Med Prim Care"},{"key":"R36-20261005","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.5588\/ijtld.18.0439","article-title":"Delays and barriers to early treatment initiation for childhood tuberculosis in India","volume":"23","author":"Valvi","year":"2019","journal-title":"Int J Tuberc Lung Dis"},{"key":"R37-20261005","first-page":"394","article-title":"Health seeking behaviour among pulmonary tuberculosis patients in rural part of central India","volume":"2","author":"Nimbarte","year":"2011","journal-title":"Int J Biomed"},{"key":"R38-20261005","doi-asserted-by":"crossref","first-page":"187","DOI":"10.5588\/pha.18.0038","article-title":"Tuberculosis retreatment outcomes and associated factors: A mixed-methods study from Puducherry, India","volume":"8","author":"Velavan","year":"2018","journal-title":"Public Health Action"},{"key":"R39-20261005","doi-asserted-by":"crossref","first-page":"e002555","DOI":"10.1136\/bmjgh-2020-002555","article-title":"Understanding why at-risk population segments do not seek care for tuberculosis: A precision public health approach in South India","volume":"5","author":"Helfinstein","year":"2020","journal-title":"BMJ Glob Health"},{"key":"R40-20261005","doi-asserted-by":"crossref","first-page":"132","DOI":"10.5588\/pha.14.0098","article-title":"MDR-TB screening in a setting with molecular diagnostic techniques: Who got tested, who didn\u2019t and why?","volume":"5","author":"Shewade","year":"2015","journal-title":"Public Health Action"},{"key":"R41-20261005","doi-asserted-by":"crossref","first-page":"8","DOI":"10.4103\/mamcjms.mamcjms_43_18","article-title":"Barriers and challenges in seeking healthcare by pediatric tuberculosis patients attending DOTS centers in urban areas of Delhi","volume":"5","author":"Dhaked","year":"2019","journal-title":"MAMC J Med Sci"},{"key":"R42-20261005","doi-asserted-by":"crossref","first-page":"e001974","DOI":"10.1136\/bmjgh-2019-001974","article-title":"Understanding pretreatment loss to follow-up of tuberculosis patients: An explanatory qualitative study in Chennai, India","volume":"5","author":"Thomas","year":"2020","journal-title":"BMJ Glob Health"},{"key":"R43-20261005","doi-asserted-by":"crossref","first-page":"62","DOI":"10.4103\/0970-0218.170990","article-title":"Socio-cultural and knowledge-based barriers to tuberculosis diagnosis for women in Bhopal, India","volume":"41","author":"McArthur","year":"2016","journal-title":"Indian J Community Med"},{"key":"R44-20261005","doi-asserted-by":"crossref","first-page":"e0196162","DOI":"10.1371\/journal.pone.0196162","article-title":"Provider reported barriers and solutions to improve testing among tuberculosis patients \u2018eligible for drug susceptibility test\u2019: A qualitative study from programmatic setting in India","volume":"13","author":"Shewade","year":"2018","journal-title":"PLoS One"},{"issue":"Suppl 2","key":"R45-20261005","doi-asserted-by":"crossref","first-page":"S497","DOI":"10.1093\/ofid\/ofz360.1236","article-title":"Patient\u2019s perceptions of barriers to tuberculosis care in private sector in India","volume":"6","author":"Yerramilli","year":"2019","journal-title":"Open Forum Infect Dis"},{"key":"R46-20261005","doi-asserted-by":"crossref","first-page":"e1004409","DOI":"10.1371\/journal.pmed.1004409","article-title":"Barriers to engagement in the care cascade for tuberculosis disease in India: A systematic review of quantitative studies","volume":"21","author":"Jhaveri","year":"2024","journal-title":"PLoS Med"},{"key":"R47-20261005","doi-asserted-by":"crossref","first-page":"100144","DOI":"10.1016\/j.jctube.2020.100144","article-title":"Closing gaps in the tuberculosis care cascade: An action-oriented research agenda","volume":"19","author":"Subbaraman","year":"2020","journal-title":"J Clin Tuberc Other Mycobact Dis"},{"key":"R48-20261005","doi-asserted-by":"crossref","first-page":"133","DOI":"10.5588\/ijtld.17.0608","article-title":"People- and patient-centred care for tuberculosis: Models of care for tuberculosis","volume":"22","author":"Odone","year":"2018","journal-title":"Int J Tuberc Lung Dis"},{"key":"R49-20261005","doi-asserted-by":"crossref","first-page":"e000326","DOI":"10.1136\/bmjgh-2017-000326","article-title":"India\u2019s plan to eliminate tuberculosis by 2025: Converting rhetoric into reality","volume":"2","author":"Pai","year":"2016","journal-title":"BMJ Glob Health"},{"key":"R50-20261005","doi-asserted-by":"crossref","first-page":"9","DOI":"10.5334\/ijic.4641","article-title":"Legitimising inter-sectoral public health policies: A challenge for professional identities?","volume":"19","author":"Synnev\u00e5g","year":"2019","journal-title":"Int J Integr Care"},{"key":"R51-20261005","doi-asserted-by":"crossref","first-page":"301","DOI":"10.4097\/kja.25001","article-title":"Heterogeneity in meta-analyses: An unavoidable challenge worth exploring","volume":"78","author":"Choi","year":"2025","journal-title":"Korean J Anesthesiol"}],"container-title":["Journal of Global Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jgid.jgid_203_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:00:37Z","timestamp":1791201637000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jgid.jgid_203_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":51,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jgid.jgid_203_25","relation":{},"ISSN":["0974-777X","0974-8245"],"issn-type":[{"value":"0974-777X","type":"print"},{"value":"0974-8245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2025-08-01","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-02","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}