Neeraj Raizada, Mudit Sharma, Monika Gupta, Vishal Bankwar, Shubham Sharma
Background: Despite free diagnostic and treatment services under the National Tuberculosis Elimination Programme, patients with tuberculosis continue to experience diagnostic delays and financial hardship. Understanding the interaction between care pathways, diagnostic sequencing, and out-of-pocket expenditure is important for identifying operational gaps. The objectives were to analyse TB care pathways from first contact to treatment initiation, quantify delays, and estimate economic burden, focusing on provider fragmentation and diagnostic sequencing. Methods: A cross-sectional analytical study was conducted among 56 TB patients at a private medical college hospital in North India from August to November 2025. Data on care pathways, diagnostic timelines, molecular testing, treatment initiation, costs, and social protection were collected using a structured questionnaire. Results: Median time from symptom onset to appropriate treatment was 48 days (IQR: 30-85). Patients consulting ≥3 providers had longer time to diagnosis and treatment than those consulting one provider (p=0.018 and p=0.024, respectively). Only 55.4% underwent NAAT before treatment. Median TB-related cost was ₹18,500; costs increased with provider fragmentation (p=0.004), and catastrophic costs occurred in 25.0% of households. Conclusion: Fragmented pathways and delayed diagnostic sequencing were associated with prolonged delays and financial burden. Strengthening early referral and timely molecular testing requires further programmatic evaluation.