The resurgence of tuberculosis in Honduras throughout the 1990's has resulted in new efforts to improve case management, including the international recognized DOTS strategy. While the National Tuberculosis Program has achieved very high rates of treatment success, case detection remains undesirably low. This study was undertaken to identify barriers to care for symptomatic individuals seeking care at the primary health care level in an urban area with high rates of TB/HIV co-infection. A cross-sectional survey was conducted among patients presenting with cough of more than 15 days at 8 public sector clinics, using a standardized questionnaire and face-to-face interviews with local research assistants. The data were analyzed with a binary logistic regression model where hypothesized relationships between key independent variables and delay (0 = less than 3 weeks, 1 = more than 3 weeks) in seeking treatment were explored. Age and location of clinic were found to be significant predictors of delayed health seeking. Recommendations include greater recognition of structural barriers in research on barriers to care, such as those related to the health system. Additionally, there is a need for more community-based research in this area, as most published research is facility-based and provides a biased view of the behavioral and structural barriers to TB diagnosis
