Background: A late diagnosis of tuberculosis has serious consequences for the spread and outcome of the disease. Delayed diagnosis is an important indicator of the quality of a tuberculosis control program. The aim of this study is to identify the determinants of delay in tuberculosis treatment for patients with positive pulmonary tuberculosis followed at TB diagnosis and treatment health centers in Democratic Republic of the Congo (DRC). Methods: A facility-based cross-sectional study was designed to analyze data from a representative sample of patients with positive pulmonary tuberculosis followed at Tuberculosis Diagnosis and Treatment Health Centers (TBDTHC) in 6 provinces of the DRC. We used logistic regression to identify the determinants of the delay in tuberculosis treatment. The level of statistical significance was p < 0.05. Results: The TB Local Network (TBLON) project recruited a total of 1365 patients in 6 TB management provinces. More than half (58.7%) of the participants were male, and 45.8% were aged between 19 and 39. About 2.9% were HIV positive and 8.6% MDR-TB. The management of more than half of the patients (53.3%) took more than 2 days. Determinants of delay in treatment were patients’ formal and informal occupations (aOR: 4.87, 95% CI: 3.19 - 7.45; aOR: 1.90, 95% CI: 1.23 - 2.93); single and married status (aOR: 3.75, 95% CI: 1.58 - 8.93; aOR: 6.04, 95% CI: 3.30 - 11.05); provenance from a public institution (aOR: 7.79 IC 95%: 2.55 - 10.83); and TBMR status (aOR: 3.89, 95% CI: 2.28 - 6.66). Conclusion: This study highlights the persistence of treatment delays among TB patients in the DRC and identifies key sociodemographic and systemic determinants, including marital status, occupation, type of health facility, and MDR-TB status. Addressing these delays will require strengthened referral systems, improved MDR-TB diagnostic protocols, and targeted community awareness interventions to ensure early treatment initiation and limit disease transmission.
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