Implications of pre-diagnosis costs incurred by patients and their families for tuberculosis-related health-seeking behaviors in Mbeya and Songwe regions, Tanzania

Background: Pulmonary tuberculosis (PTB), remains one of the leading causes of death from infectious diseases worldwide, its burden is disproportionately affecting low- and middle-income countries (LMICs), including Tanzania. This study aimed to examine the direct and indirect costs incurred by patients and their families prior to PTB diagnosis, and how such costs influence patients’ health-seeking behaviours. Methods: A mixed-methods approach was employed, integrating qualitative and quantitative methods for data collection, analysis, and interpretation. The study was part of a longitudinal observational cohort that included 261 adults diagnosed with PTB. Quantitative data were collected using a structured questionnaire adapted from the WHO’s generic patient cost survey tool, administered after TB diagnosis was confirmed. To gain deeper insights, additional data were gathered through, in-depth interviews (IDIs) with purposively selected participants, aimed at identifying both financial and non-financial challenges experienced by patients and their family supporters before to diagnosis. Results: Of the 261 respondents, 59% were men, 48% were married, and 51% were living with HIV, with a median age of 35 years. The majority 185(72.8%) delaying visiting a healthcare facility (HCF) by more than four weeks following the onset of symptoms. The average total pre-treatment cost per patient was USD 28.8, comprising direct medical, direct non-medical, and indirect costs. These costs varied based on the number and type of healthcare providers consulted. Qualitative findings indicated that participants frequently associated this pre-treatment costs with delays in seeking formal care, often influenced by self-medication, limited awareness of TB symptoms, and long distances to formal HCFs. Conclusion: This study highlights the significant financial and non-financial barriers faces by patients diagnosed with PTB and their families before diagnosis. Delays in care-seeking not only worsen health outcomes but also increase the overall economic burden. Addressing these challenges requires a comprehensive, multisectoral approach to improve early diagnosis, reduce patients costs and strengthen TB control efforts in high-burden settings.