Background: Tuberculosis (TB) remains a public health problem in middle and low-income countries. Delay in tuberculosis diagnosis may also lead to a more advanced disease and complications that may result in poor treatment outcomes. Objective: to identify the importance of early diagnosis and management of TB by assessing its relation with treatment failure. Method: The study was conducted on 2 phases. First phase was cross-sectional study to estimate the proportion and duration of delay in diagnosis and management of TB. Cut off point using median value of delay was used to classify patients into either delayed or non-delayed patients. The second phase was a cohort study. The two groups of patients were followed for 6 months to assess treatment failure. The study included 189 TB patients who were registered in directly observed treatment of short course program (DOTs) from January 2017 to January of 2018. Data was collected by an interview questionnaire. Results: Near half of patients (49.20%) had unacceptable total TB delay with a median value of 65 days (range: 6–244 days). Regarding treatment outcome; 101 (55.2%) of patients were cured, while 12 (6.6%) of patients reported treatment failure which is defined by WHO as A TB patient whose sputum smears or culture is positive at month 5 or later during treatment. Among 90 patients who had delay in diagnosis and management of TB, eight (8.8%) of them developed treatment failure but this was not statistically significant (p value =0.21). Conclusions: Delay in diagnosis and management of TB was not a predictor of treatment failure though 8.8% of patients who had delay in diagnosis and management of TB, developed treatment failure.