Background. Delay in pulmonary tuberculosis (PTB) diagnosis is one of the major factors that affect outcome and threatens continued spread of tuberculosis. This study aimed at determining factors associated with delayed PTB diagnosis among human immunodeficiency virus (HIV) infected individuals. Methods. A retrospective observational study was done using clinic records of HIV-infected PTB suspects attending an HIV/AIDS clinic at Tintswalo rural hospital in South Africa (SA) between January 2006 and December 2007. Using routine clinic registers, 480 records were identified. Results. PTB diagnosis delay was found among 77/176 (43.8%) of the patients diagnosed with PTB. The mean delay of PTB diagnosis was 170.6 days; diagnosis delay ranged 1–30 days in 27 (35.1%) patients, 31–180 days in 24 (33.8%) patients; 24 (31.2%) patients remained undiagnosed for ≥180 days. Independent factors associated with delayed diagnosis were: older age >40 years (Odds Ratio (OR) 3.43, 95% CI 1.45–8.08) and virological failure (OR 2.72, 95% CI 1.09–6.74). Conclusion. There is a considerable delayed PTB diagnosis among HIV-infected patients in rural SA. Older patients as well as patients with high viral load are at a higher risk of PTB diagnosis delay. Therefore efforts to reduce PTB diagnosis delay need to emphasised. 1. Background An estimated one-third of the world’s population is infected with tuberculosis (TB) [1]. The human immunodeficiency virus (HIV) pandemic has resulted in dramatic increases in TB case notification rates, particularly in resource-limited settings [2]. This is because people living with HIV have a much greater risk of developing active TB than HIV-uninfected individuals [3]. South Africa is one of the countries most heavily affected by the dual HIV and TB epidemics [4], with an estimated 31% of all global TB cases occurring among HIV-positive individuals [5]. For example, in Gugulethu, a township in Cape Town, over half of antiretroviral therapy (ART) clinic attendees had previously been treated for TB, one-quarter were diagnosed with active TB, and a further 10% developed TB during the first year following initiation onto lifelong ART [6]. In resource-limited settings, where the majority of HIV-TB cases occur, TB diagnostics are frequently limited to sputum smear microscopy, despite the increased likelihood of smear negative disease among immunosuppressed patients [7]. This scenario complicates TB diagnosis and frequently results in delay in TB diagnosis in HIV-infected patients [8]. This delayed detection often leads to increased mortality and
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