Diagnostic delay among tuberculosis (TB) patients leads to late anti-TB treatment initiation, which is associated with poor prognosis and increased TB transmission. Despite its recognized negative consequences, diagnostic delay among TB patients is common in developing countries, including Afghanistan, where evidence on its predictors is limited. We aimed to evaluate diagnostic delay and its predictors among newly diagnosed TB patients attending healthcare facilities in Kandahar, Afghanistan.

A multicenter, cross-sectional study was conducted in Kandahar between February and May 2025. Newly diagnosed TB patients aged 18 years or older were randomly recruited from the TB care centers of six healthcare facilities. Delays in TB diagnosis encompassed both patient and healthcare system delays. The predictors of diagnostic delay were identified using a multivariable logistic regression model.

Patient and health system delays were noted in 44% and 59.4% of cases, respectively. Patients’ low education level, extrapulmonary TB, longer distance to healthcare facility, and positive history of self-medication were significant predictors of diagnostic delays.

Despite the well-established benefits of early TB diagnosis, this study revealed that delay in TB diagnosis is still a public health challenge in Kandahar province. Late presentation for TB care was a result of factors that relate to the patient’s education, TB type, distance to healthcare facility, and history of self-medication. Therefore, focusing extra attention on these factors could potentially reduce diagnostic delays among TB patients in Afghanistan.